Tuberculosis - World Health Organization...Tuberculosis control in the Western Pacific Region: 2008 Report 1. Tuberculosis – epidemiology. 2. Tuberculosis – prevention and control.

TuberculosisControl

in the Western Pacific Region

2008 Report

Prepared by

Dr Wanitchaya Kittikraisak was the lead author of this report. The following WHO staff from the regional and the

country offices contributed to the report: Pieter van Maaren, Philippe Glaziou, Katsunori Osuga, Bernard Tomas,

Ota Masaki, Cornelia Hennig, Liu Yuhong, Giampaolo Mezzabotta, Nguyen Nhat Linh, Jacques Sebert,

Jamhoih Tonsing, Michael Voniatis and Rajendra Yadav.

Correspondence: [email protected]

Acknowledgements

We would like to thank the national TB control programme (NTP) managers and statisticians from all countries

and areas of the Western Pacific Region for providing data for this publication and to the Stop TB team in the TB

Monitoring and Evaluation unit at WHO headquarters responsible for the 2008 Global TB Report.

WHO Library Cataloguing in Publication Data

Tuberculosis control in the Western Pacific Region: 2008 Report

1. Tuberculosis – epidemiology. 2. Tuberculosis – prevention and control. 3. Tuberculosis – drug therapy. 4. Directly

observed therapy – utilization. 5. Tuberculosis, Multidrug-resistant. 6. Western Pacific.

ISBN 978 92 9061 385 5 (NLM Classification: WF 200)

© World Health Organization 2008

All rights reserved.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion

whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or

of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate

border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or

recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and

omissions excepted, the names of proprietary products are distinguished by initial capital letters.

The World Health Organization does not warrant that the information contained in this publication is complete and correct and

shall not be liable for any damages incurred as a result of its use. Publications of the World Health Organization can be obtained

from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22791

2476; fax: +41 22791 4857; e-mail: [email protected]). Requests for permission to reproduce WHO publications, in part or in

whole, or to translate them - whether for sale or for noncommercial distribution - should be addressed to Publications, at the

above address (fax: +41 22 791 4806; e-mail: [email protected]). For WHO Western Pacific Regional Publications, request

for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the

Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, fax: +632 521 1036, e-mail: [email protected]

Tuberculosis Control in the Western Pacific : 2008 Report v

ContentsList of figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

List of tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vi

List of abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix

Summary Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2.1 Estimated burden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2.2 Trend of prevalence and TB mortality rates towards goals in 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2.3 Case notification and trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2.3.1 Trends of average age of TB cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2.4 DOTS coverage, case detection, and trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

2.5 Drug resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

2.6 TB-HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.6.1 Estimated prevalence of HIV among new TB cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.6.2 Surveillance on HIV in TB cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.6.3 Anti-retroviral therapy, co-trimoxazole prophylaxis, screening

of TB for people living with HIV, and isoniazid prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.6.4 Regional TB-HIV framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.6.5 Risk factors for increased case fatality rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

3 Treatment outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

4 TB laboratory services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

4.1 Laboratory capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

4.2 Supranational reference laboratory network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

5 Financing TB control programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

5.1 NTP budgets and estimated total costs for TB control, 2002-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

5.2 NTP budgets and estimated costs per patient, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

5.3 Expenditures in 2006 compared with available funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

6 Profiles of countries with a high burden of TB in the Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

6.1 Cambodia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

6.2 China . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

6.3 The Lao People's Democratic Republic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

6.4 Mongolia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

6.5 Papua New Guinea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

6.6 The Philippines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

6.7 Viet Nam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

vi Tuberculosis Control in the Western Pacific : 2008 Report

7 Summary of the TB burden and epidemiologic indicators

of countries and areas with an intermediate burden of TB in the Region . . . . . . . . . . . . . . . . . . . . . . . . . 51

7.1 Estimated burden and trend towards 2010 goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

7.2 Case notification and trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

7.3 Drug resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

7.4 TB-HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

7.5 Treatment outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

7.6 Laboratory services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

8 Summary of the TB burden and epidemiologic indicators

of Pacific island countries and areas in the Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Annex 1: Estimation of prevalence and TB mortality rates for future years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Annex 2: Estimation of MDR-TB prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Annex 3: Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 1. Definitions of tuberculosis cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 2. Definitions of treatment outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 3. Indicators to assess treatment outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 4. Case detection rate and DOTS detection rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 5. Definitions of MDR-TB and XDR-TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Annex 4: Formulas for estimating tuberculosis incidence, prevalence, and mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Annex 5: Explanatory notes for tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Annex 6: Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Annex 7: Multidrug-resistant TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Annex 8: Notified prevalence of resistance to anti-TB drugs (1997–2006) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Tuberculosis Control in the Western Pacific : 2008 Report vii

List of figuresFigure 1: Incidence (left) and prevalence (right) rates of all forms of TB by country and area, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Figure 2: The number of estimated incident cases (all forms) among countries with a high burden of TB in the Region, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Figure 3: Case notification rates (all forms of TB) per 100 000 population in countries and areas

in the Western Pacific Region and neighbouring countries and areas, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Figure 4: Case notification rates (all forms of TB and smear-positive cases) in the Region, 1990–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Figure 5: Smear-positive notification rates, by age and sex, in seven countries with a high burden of TB, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Figure 6: The distribution of sex ratio (male to female) of case notification rates of smear-positive cases

by age group in Cambodia and Viet Nam, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Figure 7: Trend of average age of males and females with sputum smear-positive TB, 2000–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Figure 8: Annual average rate of change in notification rate by age group in selected countries and areas in the Region, 2000–2006 . . . . . . . . . . . . . . . . . . . . . . . .9

Figure 9: Trends in DOTS coverage and case detection in smear-positive cases in the Region, 1995–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Figure 10: Geographical distribution of proportion of MDR-TB among new (left) and re-treatment (right) TB cases

by country and area in the Region and by province in China, 2000–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Figure 11: Percentage of MDR-TB among new (left) and re-treatment (right) cases in countries and areas with a high burden of TB, 2006 . . . . . . . . . . . . . . . .15

Figure 12: Estimated prevalence of HIV in new TB cases against prevalence of HIV in adults in countries in the Region, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Figure 13: Percentage of uptake of HIV testing among TB patients in countries and areas in the Region with available reports, 2006 . . . . . . . . . . . . . . . . . . . . . . . .18

Figure 14: Case fatality rates against prevalence of HIV in TB cases in some countries with high and intermediate

burdens of TB in the Region, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Figure 15: Treatment outcomes for new smear-positive cases registered in 2005 in DOTS areas in countries

with a high burden of TB in the Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Figure 16: Unfavourable outcomes among new smear-positive cases and re-treatment smear-positive cases registered

in 2005 in DOTS areas in the Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Figure 17: NTP budgets, estimated total TB control cost, and sources of funding in four countries with a high burden

of TB in the Region, 2002–2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Figure 18: NTP budget by line item and key TB indicators in four countries with a high burden of TB in the Region, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Figure 19: Estimated total TB control costs and national TB control programme budgets per patient in four countries

with a high burden of TB, 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Figure 20: Cambodia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

Figure 21: Trend of case notification rates (all forms of TB and smear-positive), 1990–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Figure 22: Case notification rates by age and sex, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Figure 23: China . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32



Figure 26: The Lao People’s Democratic Republic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35



Figure 29: Mongolia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38



Figure 32: Papua New Guinea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41



Figure 35: The Philippines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44



Figure 38: Viet Nam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47



Figure 41: Prevalence, incidence, and mortality rates per 100 000 population in countries and areas

with an intermediate burden of TB in the Region, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

viii Tuberculosis Control in the Western Pacific : 2008 Report

Figure 42: Case notification rates of all forms of TB in countries and areas with an intermediate TB burden in the Region, 1990–2006 . . . . . . . . . . . . . . . . . . . . .52

Figure 43: Smear-positive notification rates, by age and sex, in countries and areas with an intermediate burden of TB, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53

Figure 44: Treatment outcomes for new smear-positive cases registered in 2005 in DOTS areas in countries and areas

with an intermediate burden of TB in the Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

Figure 45: Unfavourable outcomes among new smear-positive cases registered in 2005 in DOTS areas in countries

and areas with an intermediate burden of TB in the Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

Figure 46: Geographic distribution of the Pacific island countries and areas and their grouping (and see Table 34) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

Figure 47: Case notification rates (all forms of TB and smear-positive cases) in the Pacific island countries and areas in the Region, 2006 . . . . . . . . . . . . . . . . .59

Figure 48: TB notification rates and gross domestic product in Pacific island countries and areas in the Region, 2000–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

List of tablesTable 1: Main TB indicators 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii

Table 2: Estimated prevalence (all forms of TB) and TB mortality rates per 100 000 population in the Region, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Table 3: Estimated TB prevalence and mortality rates in 2010 by countries

with a high burden of TB in the Region, and Regional 2010 goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Table 4: Case detection rates of smear-positive cases in countries with a high burden of TB in the Region, 2005–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Table 5: Anti-TB drug resistance in recent surveys, by country and area, 2005–2008 (see Annex 8 for more detailed data) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Table 6: Estimated prevalence of HIV in new TB cases in selected countries in the Region, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Table 7: Surveillance data on HIV in TB cases in selected countries in the Region, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Table 8: External quality assessment of sputum smear microscopy in countries with a high burden of TB in the Region, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Table 9: Laboratory services in countries with a high burden of TB in the Region, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

Table 10: Supranational reference laboratories in the Region and countries and areas to which they provide support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

Table 11: Key indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

Table 12: Surveillance and DOTS implementation (2006) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Table 13: Trend of DOTS performance indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31



















Table 32: Estimated prevalence and mortality in 2010 and goals to halve the prevalence

and mortality rates of 2000 in countries or areas with an intermediate burden of TB in the Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52

Table 33: Anti-TB drug resistance surveys in countries and areas with an intermediate burden of TB, 2002–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54

Table 34: Key indicators of TB control in the Pacific island countries and areas in the Region, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

Table 35: Estimated burden of TB, 2000 and 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70

Table 36: Whole country and area case notifications and case detection rates, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72

Table 37: DOTS coverage, case notifications and case detection rates, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74

Tuberculosis Control in the Western Pacific : 2008 Report ix

List of abbreviationsART antiretroviral therapyCI confidence intervalCPT co-trimoxazole preventive therapy DOTS directly observed treatment, short-courseDRS drug resistance surveillanceDST drug susceptibility testingEQA external quality assessmentIDU injecting drug userIPT isoniazid preventive therapyMDR-TB multidrug-resistant tuberculosisNTP national tuberculosis control programmePLWHA people living with HIV/AIDSss+ or ss- sputum smear-positive or sputum smear-negativeSRLN Supranational Reference Laboratory NetworkTB tuberculosisWHO World Health Organization

Table 38: Laboratory services, management of MDR-TB and collaborative TB-HIV activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76

Table 39: Treatment outcomes, 2005 cohort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78

Table 40: Re-treatment outcomes, 2005 cohort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80

Table 41: DOTS treatment success and case detection rates, 1994–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82

Table 42: New smear-positive case notification by age and sex, absolute numbers, DOTS and non-DOTS, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84

Table 43: New smear-positive case notification rates by age and sex, DOTS and non-DOTS, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86

Table 44: Number of TB cases notified, 1980–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88

Table 45: Case notification rates, 1980–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90

Table 46: New smear-positive cases notified, numbers and rates, 1993–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92

Table 47: Estimated numbers and proportion of MDR-TB cases in new TB and re-treatment cases in countries with a high burden of TB, 2006 . . . . . . . .94

Table 48: Notified prevalence of resistance to specific drugs among new TB cases tested for resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94

Table 49: Notified prevalence of resistance to specific drugs among previously treated TB cases tested for resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96

Table 50: Notified prevalence of resistance to specific drugs among all TB cases tested for resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98

Table 51: Notified prevalence of extensively drug resistant TB (XDR-TB) among MDR-TB, 2002–2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100

7 | SUMMARY OF THE TB BURDEN AND EPIDEMIOLOGIC INDICATORS

Tuberculosis Control in the Western Pacific : 2008 Report xi

Executive summary

The status of the tuberculosis (TB) epidemic and progress in control of the disease has been assessed annually by the Regional Office for the Western Pacific of the World Health Organization (WHO) since 1997. This report presents an overview of progress in reducing the burden of TB in the Western Pacific Region (the Region) using data on disease burden and case notifications in 2006 and treatment outcomes for patients registered in 2005. 1 Financial data cover the period from 2002 to 2008. The data were collected from 35 countries and areas in the Region using the WHO standard form for reporting surveillance data. This report highlights the following:

TB burden: There were an estimated 1.9 million incident cases of TB in 2006 (109 per 100 000 population), including 0.9 million new smear-positive cases (45% of the total) and approximately 23 000 TB and human immunodeficiency virus (HIV) co-infected cases (1.0% of the total). In absolute terms, China, the Philippines, Viet Nam, and Cambodia ranked the first to fourth, respectively. These four countries accounted for 93% of the total estimated incident cases in the Region. Cambodia had the highest incidence rate (500 per 100 000 population). The summary of the data is shown in Table 1.

Trend of prevalence and TB mortality rates towards goal in 2010: Accelerated efforts are needed to achieve the goals to halve the prevalence and mortality rates of 2000 by 2010. With the current estimation, the prevalence would be 163 [95% confidence interval (CI), 152 to 176] and 14 TB deaths (95% CI, 13 to 15) per 100 000 population in 2010, while the prevalence and the mortality rates in 2000 were estimated to be 261 and 21 per 100 000 population, respectively.

Case finding: The regional case detection rate for new smear-positive cases in 2006 was sustained high at 78% (671 254 new smear-positive cases notified out of the estimated 0.9 million new smear-positive cases). Cases from China accounted for 70% of the total notified smear-positive cases. Case detection rates in China, the Lao People’s Democratic Republic, Mongolia, the Philippines, and Viet Nam were above the 70% target.

Treatment outcomes: Of the 0.7 million new pulmonary smear-positive cases registered for treatment in directly observed treatment, short-course (DOTS) areas in 2005, treatment success rate was 92%. Treatment success rates were above the 85% target in all countries with a high burden of TB, except Papua New Guinea where it was reported at 71%.

Multidrug-resistant TB 2: Eighteen countries and areas in the Region have conducted drug resistance surveillance (DRS) since 2000, and reported the results to the Global Project on Anti-tuberculosis Drug Resistance Surveillance. Among new TB cases, the prevalence of multidrug-resistant TB (MDR-TB) ranged from 0% in Cambodia to 11.1% in Northern Mariana Islands. MDR-TB prevalence among re-treatment cases ranged from 3.1% in Cambodia to 27.5% in Mongolia. In the five countries with a high burden of TB with available data from surveys (Cambodia, China, Mongolia, the Philippines, and Viet Nam), MDR-TB prevalence in new cases and re-treatment cases ranged from 0% in Cambodia to 4.9% in China 3 and from 3.1% in Cambodia to 27.5% in Mongolia, respectively. Notably, there were alarming rates of MDR-TB in several provinces in China among both new and re-treatment cases. The prevalence of MDR-TB among new TB cases in China was the highest in Henan Province (7.8%); prevalence among re-treatment was highest in Inner Mongolia Province (41.9%).

1 Caution needs to be exercised when interpreting data from Papua New Guinea because of incompletion in recording and reporting .2 Includes preliminary data from 2007 and 2008 .3 Weighted prevalence based on data from provinces .

xii Tuberculosis Control in the Western Pacific : 2008 Report

TB-HIV co-infection: Prevalence of HIV in new TB cases in 2006 was highest in Malaysia (11.0%) and lowest in the Philippines (0.1%). The percentage of TB patients tested for HIV in the Region remained relatively low: 2.7% of the total notified cases. There was a significant increase in the use of anti-retroviral therapy (ART) in the Region. However, detailed and complete data as well as strong collaboration in HIV and TB management are needed to be able to closely monitor the use of ART in the Region by country and area.

Laboratory services: Nearly 90% of microscopy laboratories in the Region participated in an external quality assessment (EQA) programme. The number significantly increased from 2005 with a substantial uptake of the EQA programme in the Philippines. Regionally, the number of mycobacterium culture and drug susceptibility testing (DST) facilities in the Region had rapidly increased in 2006.

Financing TB control programme: The national TB control programme (NTP) budgets of Cambodia, China, the Philippines, and Viet Nam for which financial reports were available had increased during the years 2002–2008, with a range of +11% in the Philippines to +130% in China. Routine DOTS implementation continued to account for the largest share of the NTP budgets in all four countries. The total cost of TB control in 2008 was estimated to be US$ 289 million; China accounted for 78% of the estimated total cost in the four countries. The estimated gap between the available funding and total cost of TB control in the four countries was US$ 60 million. In 2008, the total cost to treat one TB patient was estimated at approximately US$ 310. The total combined expenditure for TB control in 2006 from the four countries was US$ 175 million.

Tuberculosis Control in the Western Pacific : 2008 Report xiii

7 | SUMMARY OF THE TB BURDEN AND EPIDEMIOLOGIC INDICATORS

xiv Tuberculosis Control in the Western Pacific : 2008 Report

TABLE 1: Main TB indicators 2006

Populationthousands

DOTScover-

age%

Notified cases (DOTS + non-DOTS) Incidence and CDR

New + relapse(WHO total).

New pulmonary Est. incidence CDR

ss+ss-/unk.number

all formsnumber

ss+Number

All new %

New ss+%number rate number rate

American Samoa 65 100 4 6 3 5 6 3 69 115

Australia 20 530 97 1159 6 269 1 405 1329 595 85 45

Brunei Darussalam 382 100 202 53 128 34 15 317 140 60 91

Cambodia 14 197 100 34 660 244 19 294 136 6875 70 949 31 243 48 62

China 1 320 864 100 940 889 71 468 291 35 382 492 1 311 184 589 619 68 79

Cook Islands 14 80 1 7 0 2 1 47 0

Fiji 833 100 114 14 73 9 22 184 83 61 88

French Polynesia 259 100 69 27 24 9 28 68 31 98 78

Guam 171 100 44 26 21 12 15 64 29 69 73

Hong Kong (China) 7132 100 5356 75 1547 22 2900 4433 1995 116 78

Japan 127 953 99 25 304 20 10 159 8 9098 28 330 12 736 86 80

Kiribati 94 100 378 404 129 138 121 348 157 107 82

Lao People’s Democratic Republic 5759 100 3958 69 3041 53 457 8779 3934 44 77

Macao (China) 478 100 374 78 144 30 174 283 127 128 113

Malaysia 26 114 100 16 051 61 9414 36 4336 26 877 11 798 58 80

Marshall Islands 58 100 138 238 45 78 43 127 57 101 79

Micronesia 111 98 104 94 41 37 37 112 50 90 82

Mongolia 2605 100 5049 194 2129 82 724 4893 2201 98 97

Nauru 10 100 12 118 2 20 4 11 5 112 42

New Caledonia 238 100 48 20 9 4 22 63 28 65 32

New Zealand 4140 100 344 8 97 2 103 352 158 95 61

Niue 2 100 0 0 1 0 0

Northern Mariana Islands 82 100 51 62 15 18 32 61 28 83 54

Palau 20 100 12 59 6 30 2 10 5 116 129

Papua New Guinea 6202 40 12 620 203 1948 31 5969 15 473 6901 81 28

Philippines 86 264 100 147 305 171 85 740 99 55 964 247 740 111 468 58 77

Republic of Korea 48 050 100 37 861 79 11 513 24 18 804 42 359 19 030 83 60

Samoa 185 100 25 13 13 7 8 36 16 64 80

Singapore 4382 100 1314 30 538 12 525 1128 505 110 107

Solomon Islands 484 100 371 77 124 26 168 655 295 56 42

Tokelau 1 0 0 0 1 0 0

Tonga 100 100 18 18 14 14 3 24 11 74 127

Tuvalu 10 100 9 86 4 38 3 31 14 29 29

Vanuatu 221 100 126 57 42 19 37 128 58 98 73

Viet Nam 86 206 100 97 363 113 56 437 65 16 645 148 918 66 271 61 85

Wallis and Futuna 15 7 3

Western Pacific Region 1 764 231 100 1 331 333 75 671 254 38 506 031 1 915 285 859 596 66 78

ss+ = sputum smear-positive; ss-= sputum smear-negative; unk. = sputum smear result unknown; est. = estimated; CDR = case detection rate; re-treat. = re-treatment; rcvd. = received* 2006 value / 2000 value, expressed as a percentage. The 2010 goal is 50%.

Summary Table

Tuberculosis Control in the Western Pacific : 2008 Report xv

Cure/Success HIV-TB MDR-TB Prevalence Mortality

2005 ss+ cohort

Est. prevalencein adult incident

TB cases (%)

Re-treat.cases rcvd.

DST number

MDR in re-treat. cases

number

2000All forms

rate

2006All forms

rateAll formschange*

2000All forms

rate

2006All forms

rateAll formschange*

Cured%

Success%

75 75 – 15 12 80% 2 1 50% American Samoa

12 80 2 .5 69 10 6 7 117% 1 1 100% Australia

66 71 8 .9 56 99 177% 4 11 275% Brunei Darussalam

89 93 10 806 665 83% 102 92 90% Cambodia

92 94 0 .3 10 2 271 201 74% 20 15 75% China

100 100 – 26 24 92% 3 3 100% Cook Islands

71 71 0 .3 1 38 30 79% 5 3 60% Fiji

89 – 2 51 29 57% 6 3 50% French Polynesia

85 85 – 58 49 84% 5 6 120% Guam

74 77 – 388 8 87 64 74% 7 5 71% Hong Kong (China)

38 60 0 .4 45 29 64% 4 3 75% Japan

62 93 – 559 402 72% 64 45 70% Kiribati

85 90 1 .8 346 292 84% 28 24 86% Lao People’s Democratic Republic

93 93 – 27 87 59 68% 7 4 57% Macao (China)

69 70 11 139 125 90% 17 17 100% Malaysia

85 87 – 3 430 241 56% 47 28 60% Marshall Islands

75 80 – 2 2 171 109 64% 19 12 63% Micronesia

82 88 0 .1 250 89 285 191 67% 36 15 42% Mongolia

0 67 – 206 134 65% 21 15 71% Nauru

88 94 – 48 35 73% 5 4 80% New Caledonia

0 60 1 .3 16 11 9 82% 1 1 100% New Zealand

– 96 85 89% 10 9 90% Niue

73 73 – 84 90 107% 6 10 167% Northern Mariana Islands

100 100 – 115 51 44% 8 4 50% Palau

57 71 4 .0 637 513 81% 59 48 81% Papua New Guinea

82 89 0 .1 424 384 554 432 78% 58 45 78% Philippines

81 83 0 .7 142 123 87% 12 10 83% Republic of Korea

91 91 – 27 25 93% 3 3 100% Samoa

83 2 .7 101 3 39 25 64% 4 2 50% Singapore

56 85 – 5 289 194 67% 32 23 72% Solomon Islands

– 112 112 100% 12 12 100% Tokelau

73 73 – 34 34 100% 3 3 100% Tonga

100 100 – 723 504 70% 73 55 75% Tuvalu

64 81 – 87 65 75% 7 8 114% Vanuatu

90 92 5 .0 251 225 90% 24 23 96% Viet Nam

– 103 60 58% 11 7 64% Wallis and Futuna

89 92 1.2 1298 498 261 199 76% 21 17 81% Western Pacific Region

Tuberculosis Control in the Western Pacific : 2008 Report 1

1 Introduction

This report is the annual report on tuberculosis (TB) control published by the World Health Organization (WHO), Regional Office for the Western Pacific (WPRO). Geographically and economically, the Western Pacific Region (the Region)—which covers East Asia and the Pacific—has great diversity of natural and human resources, economic dynamism, technological expertise and agricultural productivity. The Region has a total population of 1764 million, representing approximately 27% of the world’s population. Yet in 2006, the Region accounted for 21% and 24% of the estimated global TB incidence and prevalence, respectively.

Each year 36 countries and areas 4 in the Region report data to the WHO using a standardized data collection form for reporting surveillance data. Using data on disease burden and case notifications in 2006 and treatment outcomes of patients registered for treatment in 2005, this report presents an assessment of TB epidemiology, burden, estimation and progress towards the Regional goals to halve the prevalence and mortality rates by 2010 from 2000 level. 5 The outcome targets are detection of at least 70% of new smear-positive cases and successful treatment at least 85% of cases that are detected. This report includes data on drug resistance, 6 TB-human immunodeficiency virus (HIV) surveillance, and laboratory services within the Region. Furthermore, the report presents financial data, and discusses financing of national TB control programmes (NTPs), and availability and sources of funds. The report also highlights the funding gaps for such financing between 2002 and 2008 for four countries with a high burden of TB for which detailed financial data were available. Expenditures for TB control in 2006 are also discussed.

In addition, the report provides country and area-specific data, which include epidemiologic indicators and detailed estimation of prevalence and mortality towards the 2010 goals for seven countries with a high burden of TB. There are eight annexes. The first four describe methods for estimation of prevalence, mortality, and numbers of multidrug-resistant TB 7 (MDR-TB) cases, and provide definitions and the formulas used to derive estimates. Annex 5 is explanatory notes for the tables listed in Annex 6. Estimated numbers of MDR-TB cases that had occurred in 2006 and notified prevalence of resistance to anti-TB drugs may be found in Annexes 7 and 8, respectively.

4 See Table 1 for countries and areas in the region .5 The Regional goals differ from the Millennium Development Goals .6 Including preliminary data for 2007 and 2008 .7 Isolate resists to at least isoniazid and rifampicin .


2 Epidemiology

2.1 Estimated burdenFigure 1 shows the prevalence and incidence rates of all forms of TB by country and area in the Region. In 2006, there were over 3.5 million prevalent TB cases (199 per 100 000 population). Over 1.9 million of these were new cases (109 per 100 000 population), including 0.9 million new smear-positive cases (49 per 100 000 population). The incidence rate was highest in Cambodia (500 per 100 000 population) and lowest in Australia (6 per 100 000 population). Cases from Cambodia, China, the Philippines, and Viet Nam together accounted for 93% of all incidence cases in the Region (Figure 2). Prevalence changed at an estimated rate of -4.9% annually since 2000 and at a rate of -3.4% from 2005 (Table 2).

FIGuRE 1: Incidence (left) and prevalence (right) rates of all forms of TB by country and area, 2006

0 100 200 300 400 500Australia

New ZealandAmerican Samoa

Cook IslandsSamoa

FijiJapanTonga

SingaporeFrench Polynesia

New CaledoniaGuam

NiueWallis and Futuna

PalauTokelau

VanuatuMacao (China)

Hong Kong (China)Northern Mariana Islands

Brunei DarussalamRepublic of Korea

ChinaMicronesia

MalaysiaNauru

Western Pacific RegionSolomon Islands

Lao People's Democratic RepublicViet NamMongolia

Marshall IslandsPapua New Guinea

PhilippinesTuvalu

KiribatiCambodia

rate /100 000 population

0 100 200 300 400 500 600 700Australia

New ZealandAmerican Samoa

Cook IslandsSamoa

FijiJapanTonga

SingaporeFrench Polynesia

New CaledoniaGuam

NiueWallis and Futuna

PalauTokelau

VanuatuMacao (China)

Hong Kong (China)Northern Mariana Islands

Brunei DarussalamRepublic of Korea

ChinaMicronesia

MalaysiaNauru

Western Pacific RegionSolomon Islands

Lao People's Democratic RepublicViet NamMongolia

Marshall IslandsPapua New Guinea

PhilippinesTuvalu

KiribatiCambodia

rate /100 000 population

>200/100 000 population

100–199<100

FIGuRE 2: The number of estimated incident cases (all forms) among countries with a high burden of TB in the Region, 2006

400 800 1200

OthersMongolia

Lao People's Democratic RepublicPapua New Guinea

CambodiaViet Nam

PhilippinesChina

Thousandsnumber of cases

4 Tuberculosis Control in the Western Pacific : 2008 Report

2 | EPIDEMIOLOGY

Death from TB occurred in approximately 0.3 million cases in 2006 (17 per 100 000 population). The mortality rate was highest in Cambodia (92 per 100 000 population) and lowest in American Samoa, Australia, and New Zealand (1 per 100 0000 population). Deaths from TB in China, the Philippines, and Viet Nam accounted for 89% of all TB mortality in the Region. The regional TB mortality rate declined at an estimated rate of -3.7% annually since 2000; however, it did not change compared to 2005 (Table 2).

TABLE 2: Estimated prevalence (all forms of TB) and TB mortality rates per 100 000 population in the Region, 2006

Estimated prevalence rate* Overall change (%) Annual rate of change since 2000,

% (95% CI)2000 2006 From 2000 From 2005

Prevalence 261 199 -24 -3 -4 .9 (-5 .8 to -4 .0)

mortality 20 17 -15 0 -3 .7 (-4 .7 to -2 .9)

CI = confidence interval; *rates are per 100 000 population

2.2 Trend of prevalence and TB mortality rates towards goals in 2010

Accelerated efforts are needed in order to achieve the 2010 regional goals. Regionally, prevalence and mortality had declined at rates of -4.9% per year [95% confidence interval (95% CI), -5.8% to -4.0%] and -3.7% per year (95% CI, -4.7% to -2.9%) respectively, since 2000. At the current rate of decline, in 2010 the prevalence would be 163 (95% CI, 152 to 176) and 14 TB deaths (95% CI, 13 to 15) per 100 000 population would occur (see the estimation method in Annex 1) (Table 3).

TABLE 3: Estimated TB prevalence and mortality rates in 2010 by countries with a high burden of TB in the Region, and Regional 2010 goals

Country

Prevalence rate Mortality rate

Annual rate of decline a

Estimate in 2010* 2010 goal†


Estimate in 2010* 2010 goal†

Cambodia -1 .6% 635 403 -4 .4% 74 51

China -3 .2% 184 136 -4 .7% 13 10

Lao People’s Democratic Republic -2 .6% 267 173 -3 .7% 20 14

Mongolia -6 .2% 147 143 -12 .3% 11 18

Papua New Guinea -5 .2% 377 319 -4 .6% 37 30

Philippines -3 .9% 366 277 -4 .0% 38 29

Viet Nam -1 .5% 213 126 -1 .1% 22 12

Western Pacific Region -4.9% 163 131 -3.7% 14 11

a Average from 2000 through 2006*Per 100 000 population, assuming current rate of change† Per 100 000 population

2.3 Case notification and trendsApproximately 1.3 million cases of all forms of TB were notified in 2006 (75 per 100 000 population), corresponding to 25% of the total cases notified globally. There were 0.7 million smear-positive cases notified in 2006 (38 per 100 000 population), corresponding to 27% of the total smear-positive cases notified globally. The largest number of smear-positive cases was reported from China (0.5 million), followed by the Philippines (0.09 million) and Viet Nam (0.06 million). Together with Cambodia, cases from these four countries accounted for 93% of all cases notified in the Region. Figure 3 shows case notification


2 | EPIDEMIOLOGY

rates for all forms of TB in countries and areas in the Western Pacific Region and neighbouring countries and areas in 2006. Two countries with a high burden of TB in the Region, Cambodia and Papua New Guinea, had case notification rates of ≥200 per 100 000 population.

FIGuRE 3: Case notification rates (all forms of TB) per 100 000 population in countries and areas in the Western Pacific Region and

neighbouring countries and areas, 2006

The boundaries shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. White lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2005. All rights reserved

Since 2002, the case notification rates in the Region have steadily increased from 47 to 75 per 100 000 population in all forms of TB (trend +11.8% per year; 95% CI, +5.4% to +18.2%) and from 22 to 38 per 100 000 population in new smear-positive TB cases (trend +14.7% per year; 95% CI, +6.9% to +22.5%). Compared to 2005 however, the case notification rate in new smear-positive cases in 2006 was relatively unchanged (Figure 4).

FIGuRE 4: Case notification rates (all forms of TB and smear-positive cases) in the Region, 1990–2006

0

10

20

30

40

50

60

70

80

Year

Rate

s per

1000

000 p

opula

tion

1 99 0

1 99 5

2 00 0

2 00 5

all formssmear-positive


2 | EPIDEMIOLOGY

Figure 5 shows age and sex-specific case notification rates (new smear-positive) for seven countries with a high burden of TB in the Region. In general, TB disproportionately affected males and older persons. For every female smear-positive TB case younger than 15 years of age, 1.5 to 2.8 male smear-positive TB cases were notified. In some countries such as Mongolia and Papua New Guinea, a different epidemiological pattern was observed: TB more frequently occurred in young adults.

FIGuRE 5: Smear-positive notification rates, by age and sex, in seven countries with a high burden of TB, 2006

0

50

100

150

0–

14

15

–2

4

25

–3

4

35

–4

4

45

–5

4

55

–6

4

65

+

age group

MALEFEMALE

rate

per 1

00 00

0 pop

ulatio

n

Western Pacific Region

0

200

400

600

800

1000

1200

Cambodia China

0

20

40

60

80

100

120

140

160

Lao’s People Democratic Republic

0

50

100

150

200

250

300

350

400

450

Mongolia

0

20

40

60

80

100

120

140

160

Papua New Guinea

0

10

20

30

40

50

Viet Nam

0

100

200

300

400

500

Philippines

0

50

100

150

200

250

300

350

FIGuRE 6: The distribution of sex ratio (male to female) of case notification rates of smear-positive cases by age group in Cambodia and Viet Nam, 2006

0

1

2

3

4

5

age group

Cambodia

Viet Nam

male

to fe

male

ratio

65+

0–14

15–

24

25–

34

35–

44

45–

54

55–

64


2 | EPIDEMIOLOGY

The distribution of sex ratio of notified sputum smear-positive cases by age group showed extremely different patterns from Cambodia to Viet Nam (Figure 6). Various factors may have contributed to the differing age and sex patterns of TB between Cambodia and Viet Nam. These factors include, though are not limited to: the Khmer Rouge regime in Cambodia which decimated a large proportion of the total population from 1975–79; the ensuing internal conflicts during the 1980s taking the lives of probably more males than females; and more recently, differences in the spread of the HIV epidemic between the two countries. Women in Cambodia may be more likely to seek health care than men, particularly if they have respiratory symptoms. Cambodian men may put off seeking health care and thus their TB diagnoses may be more delayed than women. The national TB prevalence survey 8 conducted in 2002 in Cambodia demonstrated that the prevalence of sputum smear-positive TB was 2.6 times as high in men as in women age ten years or older. In addition, in Viet Nam, migration may have affected more men than women in economically-productive age groups.

2.3.1 Trends of average age of TB cases

Trends in the age of TB cases reflect underlying epidemiological processes of TB infection. Stable or declining average age of overall TB patients is an indicator of on-going transmission in the population. With low or no ongoing transmission in a population, new cases of TB will largely occur among the already infected, and their average age will increase by at least one year annually. However, if new TB infections still occur among a population, the average age of TB patients from the population will be stable or even decline.

Figure 7 shows that in Cambodia, China, Japan, and Viet Nam the average age of notified TB patients within the age group of 55 years or older is rising, while the average age of reported TB cases within the younger age group is decreasing in Japan (males only), Cambodia (females only), and China and Viet Nam (both males and females). The spread of HIV infection is one possible reason for the shift towards younger adults in some countries. Another possible explanation is migrant populations from places with a high burden of TB. For example, in Japan about 20% of TB patients age 15–34 are foreign nationals. Likewise, in Brunei Darussalam, the epidemiology of TB is heavily influenced by TB in migrants. Internal migration may play a role in China and in Viet Nam, where young mobile adults from rural areas seek jobs in cities. In the Republic of Korea, by contrast, the TB patient is getting older in both age classes.

FIGuRE 7: Trend of average age of males and females with sputum smear-positive TB, 2000–2006

A. Countries with a high burden of TB

8 National TB Prevalence Survey, 2002, Ministry of Health, Cambodia .

R = 0.152

R = 0.852

37.5

38

38.5

39

39.5

40

2000 2001 2002 2003 2004 2005 2006Year

Age (

year

s)

Cambodia (15–54 years)

65

65.5

66

66.5

67

67.5

68

2000 2001 2002 2003 2004 2005 2006Year

Age (

year

s)

R = 0.922

R = 0.932

Cambodia ( 55 years)≥

Female

Male

R = 0.742

R = 0.602

YearChina (15–54 years)

R = 0.962

R = 0.932

China ( 55 years)≥

32.5

33.033.534.034.535.035.536.036.537.0

2000 2001 2002 2003 2004 2005 200666.867.067.267.467.667.868.068.268.468.668.8

2000 2001 2002 2003 2004 2005 2006

Age (

year

s)

Year

Age (

year

s)


2 | EPIDEMIOLOGY

B. Selected countries and areas with an intermediate burden of TB

R = 0.512

R = 0.552

YearPapua New Guinea (15–54 years)

Age (

year

s)

YearPapua New Guinea ( 55 years)≥

Age (

year

s)

R = 0.212

R = 0.652

60.561.061.562.062.563.063.564.064.565.065.5

2000 2001 2002 2003 2004 2005 200628.0

28.529.0

29.530.030.531.031.532.032.5

2000 2001 2002 2003 2004 2005 2006

R = 0.952

R = 0.722

YearViet Nam (15–54 years)

Age (

year

s)

YearViet Nam ( 55 years)≥

Age (

year

s)

R = 0.00292

R = 0.722

35.035.536.036.537.037.538.038.539.039.5

2000 2001 2002 2003 2004 2005 2006

68.869.069.269.469.669.870.070.270.470.6

2000 2001 2002 2003 2004 2005 2006

R = 0.532

R = 0.102

YearLao People's Democratic Republic (15–54 years)

R = 0.232

R = 0.402

Lao People's Democratic Republic ( 55 years)≥

Age (

year

s)

Year

Age (

year

s)

37.0

37.5

38.0

38.5

39.0

39.5

40.0

2000 2001 2002 2003 2004 2005 200666.0

66.5

67.0

67.5

68.0

68.5

2000 2001 2002 2003 2004 2005 2006

R = 0.252

R = 0.502

YearMongolia (15–54 years)

Age (

year

s)

29.0

29.5

30.0

30.5

31.0

31.5

32.0

32.5

33.0

2000 2001 2002 2003 2004 2005 2006Year

Mongolia ( 55 years)≥

Age (

year

s)

R = 0.0442

65.0

65.5

66.0

66.5

67.0

67.5

68.0

68.5

2000 2001 2002 2003 2004 2005 2006

R = 0.152

R = 0.502

R = 0.712

YearPhilippines (15–54 years)

Age (

year

s)

YearPhilippines ( 55 years)≥

Age (

year

s)

R = 0.012

R = 0.712

35.0

35.5

36.0

36.5

37.0

37.5

38.0

2000 2001 2002 2003 2004 2005 200665.2

65.4

65.6

65.8

66.0

66.2

66.4

66.6

66.8

2000 2001 2002 2003 2004 2005 2006

R = 0.0222

R = 0.462

YearBrunei Darussalam (15–54 years)

Age (

year

s)

YearBrunei Darussalam ( 55 years)≥

Age (

year

s)

R = 0.372

R = 0.0432

31.0

32.0

33.0

34.0

35.0

36.0

37.0

38.0

2000 2001 2002 2003 2004 2005 20065860

6264

6668

7072

74

2000 2001 2002 2003 2004 2005 2006


2 | EPIDEMIOLOGY

Figure 8 shows age and sex-specific changes in case notification in the period 2000–2006. The notification rate significantly increased in certain age groups in the Lao People’s Democratic Republic (ages 25–44 and 55–64 in males) and in the Philippines (age 15–64 in both males and females), while it declined in Viet Nam (ages 35–44 and 55–64 in females). Some of the changes reflect increases in case detection efforts, particularly in countries with a high burden of TB, e.g., China and the Philippines. In Viet Nam, declines in notification rates in older age-groups, particularly in females, were offset by increases in the 15–34 year age group, probably partly in relation to increases in HIV-related TB.

FIGuRE 8: Annual average rate of change in notification rate by age group in selected countries and areas in the Region, 2000–2006

A. Countries with a high burden of TB

R = 0.00922

R = 0.182

YearHong Kong (China) (15–54 years)

Age (

year

s)

YearHong Kong (China) ( 55 years)≥

Age (

year

s)

R = 0.662

R = 0.0772

32.033.034.035.036.037.038.039.040.041.0

2000 2001 2002 2003 2004 2005 200670.0

70.5

71.0

71.5

72.0

72.5

73.0

2000 2001 2002 2003 2004 2005 2006

R = 0.0642

R = 0.932

YearJapan (15–54 years)

Age (

year

s)

YearJapan ( 55 years)≥

Age (

year

s)

R = 0.192

R = 0.962

34.035.0

36.037.038.0

39.040.041.0

42.0

2000 2001 2002 2003 2004 2005 2006

70.5

71.0

71.5

72.0

72.5

73.0

73.5

2000 2001 2002 2003 2004 2005 2006

R = 0.122

R = 0.242

YearRepublic of Korea (15–54 years)

Age (

year

s)

YearRepublic of Korea ( 55 years)≥

Age (

year

s)

R = 0.492

R = 0.672

68.569.069.570.070.571.071.572.072.573.0

2000 2001 2002 2003 2004 2005 2006

31.0

32.033.0

34.035.0

36.037.0

38.039.0

2000 2001 2002 2003 2004 2005 2006

-10%

-5%

0%

5%

10%

15%

20%

25%

0-14 15-24 25-34 35-44 45-54 55-64 65+

Age group (years)

-15%

-10%

-5%

0%

5%

10%

15%

20%

0-14 15-24 25-34 35-44 45-54 55-64 65+

Age group (years)

Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Cambodia – Male Cambodia – Female


2 | EPIDEMIOLOGY

Age group (years) Age group (years)

Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

China – Male China – Female

-10%

-5%

0%

5%

10%15%

20%

25%

30%

35%

0-14 15-24 25-34 35-44 45-54 55-64 65+

-5%

0%

5%

10%

15%

20%

25%

30%

35%

0-14 15-24 25-34 35-44 45-54 55-64 65+


Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Lao People's Democratic Republic – Male Lao People's Democratic Republic – Female

-10%-5%0%5%

10%15%20%25%30%35%40%

0-14 15-24 25-34 35-44 45-54 55-64 65+

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

0-14 15-24 25-34 35-44 45-54 55-64 65+


Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Mongolia – Male Mongolia – Female

-20%

-15%

-10%

-5%

0%

5%

10%

15%

20%

0-14 15-24 25-34 35-44 45-54 55-64 65+

-20%

-15%

-10%

-5%

0%

5%

10%

15%

20%

0-14 15-24 25-34 35-44 45-54 55-64 65+


Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Philippines – Male Philipiines – Female

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

0-14 15-24 25-34 35-44 45-54 55-64 65+

-10%

-5%

0%

5%

10%

15%

20%

25%

30%

0-14 15-24 25-34 35-44 45-54 55-64 65+


Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Papua New Guinea – Male Papua New Guinea – Female

-30%

-20%

-10%

0%

10%20%

30%

40%

50%

60%

0-14 15-24 25-34 35-44 45-54 55-64 65+

-10%

0%

10%

20%

30%

40%

50%

60%

0-14 15-24 25-34 35-44 45-54 55-64 65+


2 | EPIDEMIOLOGY

Vertical lines represent 95% confidence intervals.

B. Countries and areas with an intermediate burden of TB


Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Viet Nam – Male Viet Nam – Female

-10%

-5%

0%

5%

10%

0-14 15-24 25-34 35-44 45-54 55-64 65+

-15%

-10%

-5%

0%

5%

10%

15%

0-14 15-24 25-34 35-44 45-54 55-64 65+


Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Brunei Darussalam – Male Brunei Darussalam – Female

-30%

-20%-10%

0%

10%20%

30%

40%

50%

60%

0-14 15-24 25-34 35-44 45-54 55-64 65+

-50%

-40%

-30%-20%

-10%

0%

10%20%

30%

40%

0-14 15-24 25-34 35-44 45-54 55-64 65+


Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Hong Kong (China) – Male Hong Kong (China) – Female

-30%-25%-20%-15%-10%

-5%0%5%

10%15%20%

0-14 15-24 25-34 35-44 45-54 55-64 65+

-40%

-30%

-20%

-10%

0%

10%

20%

30%

0-14 15-24 25-34 35-44 45-54 55-64 65+


Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Japan – Male Japan – Female

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

0-14 15-24 25-34 35-44 45-54 55-64 65+

-20%-15%-10%

-5%0%5%

10%15%20%25%30%

0-14 15-24 25-34 35-44 45-54 55-64 65+


Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Macao (China) – Male Macao (China) – Female

-30%

-20%

-10%

0%

10%

20%

30%

0-14 15-24 25-34 35-44 45-54 55-64 65+

-50%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

0-14 15-24 25-34 35-44 45-54 55-64 65+


2 | EPIDEMIOLOGY

Vertical lines represent 95% confidence intervals .In Brunei Darussalam, Macao (China), and Singapore, certain age groups are not shown because the number of cases in those groups are small, zero case was reported in a year or so, and therefore 95% confidence intervals are too wide .

2.4 DOTS coverage, case detection, and trends

Overall, directly observed treatment, short-course (DOTS) coverage in the Region was 99.7% in 2006. Thirty countries and areas, including six countries with a high burden of TB, had reached 100% coverage. The coverage is less than 50% in Papua New Guinea, while in some countries DOTS coverage is less than 100% due to reporting errors.

In 2005, the Region reached the global and regional target of detecting 70% of the estimated new sputum-positive TB cases and has sustained high case detection rates since then (Figure 9). In 2006, 23 countries and areas in the Region, including five countries with a high burden of TB—China, the Lao People’s Democratic Republic, Mongolia, the Philippines, and Viet Nam—have reached the target. A substantial improvement in case detection rates was reported from the Lao People’s Democratic Republic (+17%) and Mongolia (+18%). The target of 70% case detection rate was reached for the first time for the Lao People’s Democratic Republic (Table 4).


Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Malaysia – Male Malaysia – Female

-60%

-40%

-20%

0%

20%

40%

60%

80%

0-14 15-24 25-34 35-44 45-54 55-64 65+

-100%-80%-60%-40%-20%

0%

20%40%60%80%

100%

0-14 15-24 25-34 35-44 45-54 55-64 65+


Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Republic of Korea – Male Republic of Korea – Female

-10%

-5%

0%

5%

10%

15%

0-14 15-24 25-34 35-44 45-54 55-64 65+

-20%-15%

-10%-5%

0%

5%

10%

15%

20%

0-14 15-24 25-34 35-44 45-54 55-64 65+


Chan

ge in

notif

icatio

n rate

Chan

ge in

notif

icatio

n rate

Singapore – Male Singapore – Female

0-14 15-24 25-34 35-44 45-54 55-64 65+

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

0-14 15-24 25-34 35-44 45-54 55-64 65+-30%

-20%

-10%

0%

10%

20%

30%

40%


2 | EPIDEMIOLOGY

FIGuRE 9: Trends in DOTS coverage and case detection in smear-positive cases in the Region, 1995–2006

DOTS, directly observed treatment, short-course DOTS case detection rate was calculated by dividing annual new smear-positive notifications under DOTS with estimated annual new smear-positive incidence .

TABLE 4: Case detection rates of smear-positive cases in countries with a high burden of TB in the Region, 2005–2006

CountryDOTS coverage

in 2006 (%)

Case detection rates (%)

DOTS area

% change

DOTS + non-DOTS area*

% change2005 2006 2005 2006

Cambodia 100 66 62 -6

China 100 80 79 -1

Lao People’s Democratic Republic 100 68 77 13

Mongolia 100 82 97 18

Papua New Guinea 40 21 21 0 28 28 0

Philippines 100 75 77 3

Viet Nam 100 84 85 1

Western Pacific Region 99.7 76 77 -1 78 78 0

* Countries with 100% DOTS coverage have no non-DOTS area by definition; the figures match the left column.

2.5 Drug resistance

From 2000 through 2008, 18 countries and areas in the Region have conducted at least one round of drug-resistance surveillance (DRS) and reported the results to the Global Project on Anti-tuberculosis Drug Resistance Surveillance, which was launched in 1994. New survey data from Australia, Mongolia, New Zealand, and Northern Mariana Islands have become available in this report. TB strains resistant to any of the first-line anti-TB drugs were found in all settings surveyed in the Region. Prevalence of MDR-TB varied from country to country and by treatment history of the patient. (See Table 5, Figure 10 and Annex 8.) Among new TB cases in the Region, the prevalence ranged from 0% in Cambodia to 11.1% in Northern Mariana Islands. MDR-TB prevalence in re-treatment cases ranged from 1% in Singapore to 27.5% in Mongolia. In five countries with a high burden of TB for which surveyed data were available (Cambodia, China, Mongolia, the Philippines, and Viet Nam), MDR-TB prevalence in new cases ranged from 0% in Cambodia to 4.9% in China (weighted prevalence based on data from the provinces), and in re-treatment cases from 3.1% in Cambodia to 27.5% in Mongolia (preliminary data for 2008).

0

20

40

60

80

10019

95

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year

%

DOTS coverageCase detection rate (DOTS & non-DOTS)DOTS case detection rate100% DOTS coverage target70% case detection target


2 | EPIDEMIOLOGY

Notably, data from recent DRS in five of China’s 31 provinces had revealed alarming rates of MDR-TB in more than half of these provinces (Figure 10). In these provinces, the rate of MDR-TB in new TB cases ranged from 2% to 10%, substantially higher than the global average. MDR-TB rate was greater than 7% among new TB cases in three provinces—Henan, Heilongjiang, and Inner Mongolia—that had implemented a successful DOTS programme for nearly ten years, indicating that implementing DOTS alone may not be sufficient to control the spread of the MDR-TB epidemic in China.

TABLE 5: Anti-TB drug resistance in recent surveys, by country and area, 2005–2008 (see Annex 8 for more detailed data)

Country and area Year

New cases Re-treatment cases

# of strains tested

INH resis-tance (%)

Any resis-tance (%)

MDR(%)

# of strains tested

MDR(%)

Australia* 2005 808 8 .8 10 .1 1 .5 - -

Fiji* 2006 38 0 .0 0 .0 0 .0 - -

Mongolia† 2008 650 - 16 .6 1 .4 200 27 .5

New Caledonia* 2005 5 20 .0 20 .0 0 .0 - -

New Zealand† 2007 211 4 .7 9 .0 0 14 14 .3

Northern Mariana Islands 2006 18 16 .7 22 .2 11 .1 - -

Vanuatu 2006 29 3 .4 3 .4 0 - -

Viet Nam 2006 1619 19 .1 30 .7 2 .7 207 19 .3

# = number; INH = isoniazid; MDR-TB = multidrug-resistance tuberculosis*Combined new and re-treatment cases.†Preliminary results, some data were not yet available.

FIGuRE 10: Geographical distribution of proportion of MDR-TB among new (left) and re-treatment (right) TB cases by country and area in the Region and by province in China, 2000–2006*

*In the left map, the data from Australia, Fiji, Guam, New Caledonia, and Solomon Islands indicate new and re-treatment cases combined . Only data on new cases are available for Northern Mariana Islands and Vanuatu .

The boundaries shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. ©WHO 2005. All rights reserved


2 | EPIDEMIOLOGY

Figure 11 shows the proportions of MDR-TB cases in new and re-treatment cases estimated to have occurred by country and area in 2006 (see Annex 2 for estimation method). Globally, the Region had the highest number of estimated MDR-TB cases compared to other WHO regions. Regionally, a total of 152 694 MDR-TB cases (95% CI, 119 886 to 188 014) were estimated to have occurred in 2006 (see Annex 8).

Among new TB cases, it was estimated that 82 087 MDR-TB cases (95% CI, 57 531 to 107 804) had occurred among 1 882 930 new TB cases in the Region in 2006. The proportion of MDR-TB in new TB cases was estimated to be 4.4% (95% CI, 3.9% to 4.8%). MDR-TB cases from China, the Philippines, and Viet Nam accounted for 97% of the total MDR-TB cases among new TB cases.

For re-treatment cases, a total of 70 601 MDR-TB cases (95% CI, 47 134 to 94 543) were estimated to have occurred among 289 214 re-treatment cases in 2006 (24.4%; 95% CI, 22.7% to 26.1%). The proportion of MDR-TB in re-treatment cases was estimated to be 24.4% (95% CI, 22.7% to 26.1%). Cases from China, the Philippines, and Viet Nam accounted for 98% of the total estimated cases among re-treatment cases.

Based on the overall case management data in 2006, however, 6331 new patients and 1298 re-treatment patients were reported with available drug susceptibility testing (DST) results in the Region. Of those, 89 (1.0%) and 498 (38.4%) had MDR-TB, respectively. These numbers contrast sharply with the estimated numbers of MDR-TB cases in the Region discussed earlier. Capacity to detect and treat MDR-TB cases needs to be scaled up rapidly in the Region, particularly in the countries and areas reported to have high prevalence of MDR-TB. Prevalence of MDR-TB among routinely tested cases was high in the Philippines (57.6% in new cases and 90.6% in re-treatment cases), likely because DST was performed in the cases most at risk of MDR-TB.

FIGuRE 11: Percentage of MDR-TB among new (left) and re-treatment (right) cases in countries and areas with a high burden of TB, 2006

MDR-TB = multidrug-resistant TBVertical lines represent 95% confidence intervals of the estimates .

0

10

20

30

40

Camb

odia

Malay

siaSin

gapo

reNe

w Zea

land

Japan

Hong

Kong

Mong

olia

Macao

Repu

blic o

f Kore

aVie

t Nam

Papu

a New

Guine

aLa

o Peo

ple's D

emocr

atic R

epub

licPh

ilippin

esCh

ina

% MD

R TB

0

10

20

30

40

Malay

siaNe

w Zea

land

Singa

pore

Camb

odia

Hong

Kong

Japan

Repu

blic o

f Kore

aMa

caoVie

t Nam

Lao P

eople

's Dem

ocrati

c Rep

ublic

Papu

a New

Guine

aMo

ngoli

aPh

ilippin

esCh

ina

% MD

RTB


2 | EPIDEMIOLOGY

2.6 TB-HIV

2.6.1 Estimated prevalence of HIV among new TB cases

HIV infection fuels the TB epidemic, particularly in countries and areas with a high burden of TB, because it reduces cell-mediated immunity and is a powerful risk factor for the development of TB. The annual risk of developing active TB disease in a co-infected person ranges from 5% to 15%, depending on the degree of immune suppression. In the past 10–15 years, TB case numbers have increased by 300–400% in high HIV-prevalent countries of Africa. To a lesser extent, TB-HIV co-infection also affects some countries and areas in the Region.

Two countries in the Region, Cambodia and Papua New Guinea, had a generalized HIV epidemic (HIV prevalence >1% of pregnant women) until year 2005. The prevalence of HIV in Cambodia is now below 1% in adults age 15-49 years. The prevalence of HIV in new TB cases in 2006 was estimated to be the highest in Malaysia (11.0%), followed by Cambodia (9.6%), Brunei Darussalam (8.9%), Viet Nam (5%), and Papua New Guinea (4.0%). 9 The prevalence was the lowest in Mongolia and the Philippines (0.1%) (Table 6).

TABLE 6: Estimated prevalence of HIV in new TB cases in selected countries in the Region, 2006

Country Prevalence of HIV in new TB cases* (%)

Malaysia 11 .0

Cambodia 9 .6

Brunei Darussalam 8 .9

Viet Nam 5 .0

Papua New Guinea 4 .0

Lao People’s Democratic Republic 1 .8

China 0 .3

Mongolia 0 .1

Philippines 0 .1

*For Cambodia, the Lao People’s Democratic Republic, Malaysia, and Viet Nam direct estimation method was used for estimation based on surveillance data. Estimates may not be compared to figures published in the Global TB Control Report 2008 due to changes in estimation methods.

In all countries and areas in the Region, HIV prevalence in new TB cases is consistently higher than the prevalence of HIV in the general population (Figure 12). In Malaysia, HIV and TB cases share important risk factors and the two epidemics are highly concentrated in similar populations (i.e., injecting drug users [IDUs]).

FIGuRE 12: Estimated prevalence of HIV in new TB cases against prevalence of HIV in adults in countries in the Region, 2006

0.0

2.0

4.0

6.0

8.0

10.0

12.0

0 0.5 1 1.5 2

Prevalence of HIV in general population (%)

Prev

alenc

e of H

IV in

Incid

ent T

B (%) Brunei

DarussalamCambodia

Malaysia

Papua NewGuineaLao People’s

Democratic Republic

Viet Nam

Singapore

New Zealand

Republic of KoreaFiji and China

Mongolia and Philippines

Japan

9 For Cambodia, the Lao People’s Democratic Republic, Malaysia, and Viet Nam direct estimation method was used for estimation based on surveillance data . Estimates should not be compared to figures published in the Global TB Control Report 2008 due to changes in estimation methods .


2 | EPIDEMIOLOGY

2.6.2 Surveillance on HIV in TB casesIn some areas in Papua New Guinea, the prevalence of HIV among TB patients was considerably higher than previously estimated; data from sentinel surveillance centres in three major health facilities in Port Moresby, Goroka, and Lae showed that 12% to 19% of TB cases were HIV-infected in 2003. 10

In Cambodia, HIV prevalence has fallen to an estimated 0.9% among the adult population in 2006, down from a peak of 2.0% in 1998. Three national surveys of HIV prevalence in TB patients showed a significant decline, from 11.8% in 2003 to 9.9% in 2005 to 7.8% in 2006.

The HIV epidemic is still at the concentrated stage in other countries and areas in the Region, particularly in China and Viet Nam. The average HIV prevalence in drug users in selected sentinel sites in China was 7.5% in 2005, while that of the general population was estimated to be about 0.05%. There are also geographic variations: the HIV prevalence in IDUs in 2006 was greater than 10.0% in selected sites in Xinjiang, Henan, Sichuan, Guangxi, and Guizhou. 11 The routine surveillance data from China showed 1.3% of TB cases tested positive for HIV in 2006 (Table 7). However, because only 0.14% of all the TB cases notified in 2006 were tested, and these primarily from areas of higher HIV prevalence, the estimate is unlikely to be representative.

In Viet Nam, the estimated proportion of adults age 15–49 living with HIV had slightly increased from 2003 to 2005, from 0.4% to 0.5%. The main risk factors associated with HIV infection are the use of contaminated injecting equipment and unprotected sex with casual partners or sex workers. The prevalence of HIV infection varies across provinces even among IDUs, who are one of the highest risk groups, from 4.0% in Dong Thap Province to 36.1% in Lai Chau Province. 12 Surveillance data from 2006 showed that 15.0% of the notified TB cases were tested and 5.0% of them turned out to be TB-HIV co-infected. In Ho Chi Minh City, the prevalence had significantly increased from 1.5% in 1997-1998 to 9.0% in 2001–2002. 13 The prevalence remains high at 7.7% in selected districts of Ho Chi Minh City in 2006–2007. 14

TABLE 7: Surveillance data on HIV in TB cases in selected countries in the Region, 2006

CountryTB cases notified (new and

relapse) Tested for HIV Positive for HIVHIV-positive

among TB (%)

Cambodia* 34 660 3547 342 9 .6

China 940 889 1350 18 1 .3

Malaysia 16 051 13 039 1438 11 .0

Viet Nam 97 363 14 230 708 5 .0

Western Pacific Region 1 331 333 38 672 2632 6.8

*Cambodia made great progress in testing TB cases for HIV in 2007.

10 National Department of Health, Papua New Guinea, 2006 .11 Sun X et al. The development of HIV/AIDS surveillance in China . AIDS, 2007:21:S33-S3812 Tuang et al . Human immunodeficiency virus (HIV) infection patterns and risk behaviours in different population groups and provinces in Viet Nam . Bulletin of the

WHO, 2007:85:35-41 .13 Tran NB et al. HIV and tuberculosis in Ho Chi Minh City, Viet Nam, 1997-2002 . Emerging Infectious Diseases, 2007:13:1463-1469 .14 Data presented at the Meeting on the Revised TB-HIV Co-Infection Framework for the Western Pacific Region held in February 2008 .


2 | EPIDEMIOLOGY

The overall percentage of TB patients tested for HIV in the Region remained too low: 2.7% of the total notified cases (Figure 13). Across the 17 reporting countries and areas, HIV testing of 38 672 TB patients led to the identification of 2632 HIV positive cases, representing 6.8% of the total tested cases (Table 7) and 12.0% of the estimated burden of incident TB-HIV.

FIGuRE 13: Percentage of uptake of HIV testing among TB patients in countries and areas in the Region with available reports, 2006

0

20

40

60

80

100

Cambodia Viet Nam LaoPeople's

DemocraticRepublic

Hong Kong,China

Macao,China

Malaysia BruneiDarussalam

WPR

%

WPR = Western Pacific Region.

2.6.3 Anti-retroviral therapy, co-trimoxazole prophylaxis, screening of TB for people living with HIV, and isoniazid prophylaxis

The use of anti-retroviral therapy (ART) has expanded in the past four years in the Region. The number of people living with HIV/AIDS (PLWHA) on ART increased from 16 170 in 2004 to 83 621 in 2007. Cambodia, China, Malaysia, Papua New Guinea, and Viet Nam are countries that have more than 1000 PLWHA on ART in 2007.

ART should significantly improve the long-term survival rate for TB-HIV co-infected cases. A report from Thailand highlighted that the survival rate at one, two, and three years after TB diagnosis were 96, 94, and 88%, respectively for TB-HIV patients on ART, and 44, 19, and 9%, respectively for those not on ART. 15

Co-trimoxazole (CTX) preventive therapy (CPT) may improve TB treatment outcomes in TB-HIV co-infected cases. A report from An Giang, Viet Nam showed that patients who were not on CPT during the course of TB treatment were ten times as likely to have unsuccessful outcomes (i.e., failure, death, or default) as those who were on CPT. 16

In 2005 and 2006 there was a significant increase in the use of CPT and ART in the Region (p-value<0.01 for both). However, detailed and complete data as well as strong collaboration in HIV and TB management are needed to be able to closely monitor the use of CPT and ART in the Region.

As noted earlier, PLWHA are more likely to develop TB disease during their lifetime and this fact emphasizes the importance of TB screenings for PLWHA. Reports from Cambodia 17, 18 and Viet Nam 19 showed that 24% to 43% of PLWHA turned out to have had TB disease at the first screening. TB screenings for PLWHA yields much higher probability of finding new TB cases than screenings for any other population.

15 Manosuthi W et al . Survival rate and risk factors of mortality among HIV/TB-coinfected patients with and without antiretroviral therapy . Journal of Acquired Immune Deficiency Syndromes, 2006:43:42-6 .

16 Thuy TT et al . HIV-associated TB in An Giang Province, Viet Nam, 2001-4: Epidemiology and TB treatment outcomes . Public Library of Science, 2007:2:e507 .17 Cain KP et al . The epidemiology of HIV-associated tuberculosis in rural Cambodia . International Journal of Tuberculosis and Lung Disease, 2007:11:1008-13 .18 Kong BN et al . Opportunistic infections and HIV clinical disease stage among patients presenting for care in Phnom Penh, Cambodia . Southeast Asian of Tropical

Medicine and Public Health, 2007:38:62-68 .19 Klotz SA et al . Clinical features of HIV/AIDS patients presenting to an inner city clinic in Ho Chi Minh City, Viet Nam . International Journal of STD & AIDS, 2007:18:482-

485 .


2 | EPIDEMIOLOGY

For patients in whom TB is excluded, isoniazid preventive therapy (IPT) may be warranted. IPT is a six-month course of daily isoniazid which is given to PLWHA with latent TB infection in order to prevent the development of active TB disease. IPT has been shown to decrease TB incidence among PLWHA with latent TB infection by up to 60%.

Although the effectiveness of IPT for latent TB infection is established, implementation remains very low. IPT is implemented in Cambodia and China, and is partially implemented in Mongolia and Papua New Guinea; however, uptake remains low. Small-scale pilot projects providing IPT are implemented in Viet Nam.

2.6.4 Regional TB-HIV framework

To facilitate collaborative TB-HIV activities with the aim to reduce TB transmission and decrease the morbidity and mortality associated with TB-HIV, WHO/WPRO, in collaboration with experts on TB and HIV/AIDS, developed a regional framework for TB-HIV, published in 2004. The framework has been revised with the aim of (1) introducing new approaches to improve HIV-testing rates among TB patients through the implementation of provider-initiated testing and counselling (PITC), and to improve TB screening rates among PLWHA in the Region, and (2) scaling up TB infection control measures to prevent transmission of the disease within health facilities, such as TB clinics and HIV/AIDS clinics. The revised framework will be published in mid-2008.

2.6.5 Risk factors for increased case fatality rate

Higher case fatality rates were observed in places in which the prevalence of HIV among TB patients was high, as well as in ageing populations (Figure 14). Case fatality rates of over 20% in TB-HIV cases have been reported from various areas in the Region, likely due to their late diagnosis which made patients vulnerable not only to TB but also to other opportunistic infections such as candidiasis and Pneumocystis jiroveci infection. A report from Malaysia showed that the median CD4+ T-lymphocyte cell count of TB-HIV co-infected cases at diagnosis ranged from 44 to 58 cells/µL, 20 much lower than that observed in sub-Saharan Africa (186–393 cells/mm3).

In places in which the epidemic of TB is mature and most TB cases occur in elderly people, such as Japan and Singapore, case fatality rates are more than 10%, while HIV prevalence is low.

FIGuRE 14: Case fatality rates against prevalence of HIV in TB cases in some countries with high and intermediate burdens of TB in the Region, 2006

0 2 4 6 8 10 12

HIV prevalence in new TB (%)

case

fat

alit

y (%

)

Singapore

Japan

Lao People’s Democratic Republic Brunei Darussalam

Malaysia

CambodiaViet Nam

Republic of KoreaChina

Mongolia

05

1015

Papua New Guinea

Circle’s size is proportional to percentage of smear-positive TB cases age >65 years .

20 Nissapatorn V et al . Tuberculosis in HIV/AIDS patients: A Malaysian experience . Southeast Asian Journal of Tropical Medicine and Public Health, 2005:36:946-53 .


2 | EPIDEMIOLOGY

HIV and MDR-TB co-infection is a serious concern in places where prevalence of MDR-TB among new TB cases is high. A cohort study in Ho Chi Minh City, Viet Nam, showed that HIV and MDR-TB independently affected sputum smear-positive patients; 21 those with HIV were 30 times as likely to die during TB treatment as those without HIV, while those with MDR-TB were 4.7 times as likely to die as those with susceptible TB. 22 Another report from Thailand showed an even more alarming finding: HIV-infected persons with MDR-TB were 12 times as likely to die as those with drug-susceptible TB. 23

21 Thuy TT et al . HIV-associated TB in An Giang Province, Viet Nam, 2001-4: Epidemiology and TB treatment outcomes . Public Library of Science, 2007:2:e507 .22 Quy HT et al . Treatment outcomes by drug resistance and HIV status among tuberculosis patients in Ho Chi Minh City, Viet Nam . International Journal of Tuberculosis

and Lung Disease, 2006:10:45-51 .23 Sungkanuparph S et al . Impact of drug-resistant tuberculosis on the survival of HIV-infected patients . International Journal of Tuberculosis and Lung Disease,

2007:11:325-30 .


3 Treatment outcomes

The Region continued to observe treatment success rates beyond the target of 85%. Of 0.7 million new pulmonary smear-positive cases registered for treatment in DOTS areas in the 2005, treatment success was remarkably high, reporting at 92% overall. Across the Region, 20 countries and areas had reached the 85% treatment success target. Among the countries with a high burden of TB, the treatment success rate was highest in China (94%), followed by Cambodia (93%) and Viet Nam (92%). The treatment success rate of Papua New Guinea improved from 65% in 2004 to 71% in the 2005 cohort (Figure 15).

FIGuRE 15: Treatment outcomes for new smear-positive cases registered in 2005 in DOTS areas in countries with a high burden of TB in the Region

DOTS: directly observed treatment, short-course; Numbers in bars are treatment success rates .

Overall, unfavourable treatment outcomes of 8% and 13% were reported from the 2005 cohorts of new smear-positive cases and re-treatment smear-positive cases, respectively, and their breakdowns are shown in Figure 16. At least a quarter of unfavourable outcomes were attributable to non-evaluated cases in both cohorts, which was higher than those reported in earlier years. It should be noted that the cases reported under the category “transfer-out” can have any of the other treatment outcomes, but detailed information is simply not available, as outcomes are not recorded in the TB registers.

FIGuRE 16: Unfavourable outcomes among new smear-positive cases and re-treatment smear-positive cases registered in 2005 in DOTS areas in the Region

Number in each segment indicates the respective proportion of treatment outcome .

93 94 90 8871

89 92

0

20

40

60

80

100

OthersFailureDeathSuccess

Cam

bodi

a

Chin

a

Lao

Peop

le’s

Dem

ocra

tic R

epub

lic

Mon

golia

Papu

a N

ew G

uine

a

Phili

ppin

es

Viet

Nam

Treat

ment

outco

mes (

%)

28 24

12 21

18 14

17 14

25 28

102030405060708090

100

New N=52 033 Re-treatmentN=13 620

%

Not evaluatedTransfer outDefaultFailureDeath

0


4 TB laboratory services

4.1 Laboratory capacity

TABLE 8: External quality assessment of sputum smear microscopy in countries with a high burden of TB in the Region, 2006

Country# of smear micros-copy laboratories

Labs included in EQA (%)

% change from 2005

# of labs with unsatisfactory

result* (%)

Labs in which necessary correc-tive actions were

taken (%)

Cambodia 186 100 0 24 100

China 3010 92 2 4 100

Lao People’s Democratic Republic 155 87 -12 4 .4 67

Mongolia 36 100 0 8 100

Papua New Guinea 60 25 213 6 25

Philippines 2374 100 285 9 100

Viet Nam 874 85 -15 9 -

EQA = external quality assessment; # = number; labs = laboratories; - = no data*Definitions of unsatisfactory results may vary slightly between countries and areas. For example, in the blind slide rechecking, which is one of the three components of EQA, either one major error (i.e., high false positive or negative) or three quantitative minor errors may be considered unsatisfactory and require immediate corrective actions.The data were presented at the 2nd Laboratory Training Course for Asia-Pacific held in Ha Noi, Viet Nam in September 2007.

Across the Region, there are 7390 TB laboratories performing acid-fast bacilli smear microscopy; 6433 (87%) of which participated in external quality assessment (EQA) programmes. In six countries out of seven with a high burden of TB—Cambodia, China, the Lao People’s Democratic Republic, Mongolia, the Philippines, and Viet Nam—over 85 % of sputum smear microscopy centres participated in EQA activities, and in four countries out of the six—Cambodia, China, Mongolia, and the Philippines—100% of the laboratories with unsatisfactory results in EQA received corrective actions (Tables 8). Between 2005 and 2006, the number of laboratories participating in EQA programmes increased significantly, from 5 to 15 laboratories in Papua New Guinea and from 491 to 2374 laboratories in the Philippines.

Of the 7390, a total of 458 and 122 laboratories were capable for mycobacterium bacilli culture and for DST of anti-TB drugs, respectively. Of these, 360 and 90, respectively, were located in China (Table 9). In Cambodia, China, Mongolia, the Philippines and Viet Nam, mycobacterium culture facilities that are performing DST have been established. However, overall in the Region, the number of laboratories capable of doing culture and DST is insufficient given the threat of MDR-TB and TB-HIV co-infection and given the need to detect and treat cases under those conditions.


4 | TB LABORATORY SERVICES

TABLE 9: Laboratory services in countries with a high burden of TB in the Region, 2006

CountryPopulation(thousand)

Sputum smear Culture DST

# of labs/100 000

pop

% change from 2005 # of labs

/5 mil.pop

% change from 2005 # of labs

/10 mil. pop

% change from 2005

Cambodia 14 197 186 1 .3 0 3 1 .1 0 1 0 .7 0

China 1 320 864 3010 0 .2 0 360 1 .4 180 90 0 .7 75

Lao People’s Democratic Republic 5759 155 2 .7 4 0 0 .0 0 0 0 .0 0

Mongolia 2605 36 1 .4 8 1 1 .9 -5 1 3 .8 -5

Papua New Guinea 6202 60 1 .0 0 1 0 .8 0 1 1 .6 n/a*

Philippines 86 264 2374 2 .8 27 3 0 .2 0 3 0 .3 -25

Viet Nam 86 206 874 1 .0 11 18 1 .0 -44 2 0 .2 0

# = number; labs = laboratories; pop = population; DST = drug susceptibility testing; mil =million To provide culture for diagnosis of paediatric, extrapulmonary and smear-negative HIV-infected TB cases, as well as DST for re-treatment and failure cases, most countries and areas will need one culture facility per five million population and one DST facility per ten million population. However, for countries and areas with large populations, one laboratory for culture and DST in each major administrative area (e.g., province) may be sufficient.*There was no DST facility in Papua New Guinea in 2005.

4.2 Supranational reference laboratory network

A network of laboratories was developed in conjunction with the Global Project on Anti-tuberculosis Drug Resistance Surveillance (see section 2.5 Drug resistance) and named the Supranational Reference Laboratory Network (SRLN). The SRLN participates in annual proficiency testing and has a mandate to assist national reference laboratories in laboratory assessments: in proficiency testing, quality assurance of results from drug resistance surveys, and other technical guidance as necessary. There are six supranational reference laboratories in the Region (Table 10).

TABLE 10: Supranational reference laboratories in the Region and countries and areas to which they provide support

Supranational reference laboratory Countries and areas

Institute of Medical and Veterinary Science (IMVS), Adelaide, Australia Viet Nam, Pacific island countries and areas

Korean Institute of Tuberculosis (KIT), Seoul, Republic of Korea The Philippines

Queensland Mycobacterium Reference Laboratory (QMRL), Brisbane, Australia Papua New Guinea, Pacific island countries and areas

Research Institute of Tuberculosis (RIT), Tokyo, Japan Cambodia, Mongolia, the Philippines

Tuberculosis Reference Laboratory, Department of Health, Hong Kong, China China, Lao People’s Democratic Republic

The Centres for Disease Control and Prevention (CDC), Atlanta, USA, through Diagnostic Laboratory Services, Inc .*, Hawaii, USA

American Samoa, Guam, Northern Mariana Islands, Marshall Islands, Micronesia, Palau

*Not a member of the Supranational Reference Laboratory Network (SRLN)

In the Pacific island countries and areas, a TB laboratory network has been put in place since 2004, in collaboration with the Institute of Medical and Veterinary Science, Adelaide, Australia; the Queensland Mycobacterium Reference Laboratory, Brisbane, Australia; the Pacific Paramedical Training Centre (PPTC) in Wellington, New Zealand; the Secretariat of the Pacific Community (SPC); US Centers for Disease Control and Prevention and WHO. The network is called the Pacific TB Laboratory (PaTLab) Initiative. The primary objectives of the PaTLab are to improve the quality of sputum microscopy by application of EQA, and to expand surveillance for TB drug resistance. PaTLab coordinates EQA of sputum smear microscopy, including panel testing, blinded slide rechecking, and onsite visits. The PaTLab has initiated drug resistance surveys in some Pacific island countries and areas, as described in Section 2.5. PaTLab has contributed significantly to the quality improvement of TB laboratory services in Pacific island countries and areas.


5 Financing TB control programmes

5.1 NTP budgets and estimated total costs for TB control, 2002-2008

Thirty countries and areas in the Region provided financial reports. None of the seven countries with a high burden of TB is a high-income country. 24 The four countries with a high burden of TB—Cambodia, China, the Philippines, and Viet Nam—that provided financial reports accounted for 92% of the regional burden of TB. NTP budgets in these four countries have increased during the years 2002–2008 with a range of +11% in the Philippines to a striking +130% in China. The extraordinary budgetary increase in China came from additional domestic funding. By contrast, the increasing funds in the Philippines and Viet Nam came primarily from the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund). The relatively small increase in funding in the Philippines (+11%) and Viet Nam (+27%) reflect the fact that both countries had achieved or were close to achieving the global targets for TB control in 2002. In 2008, local governments will provide US$ 155 million (58%) of the required NTP funding in the four countries, donor agencies will fund US$ 40 million (15%), and US$ 13 million (5%) will be loans (Figure 17). China was the only country or area reporting taking loans to fill its budget needs. This left a reported funding gap of US$ 60 million in total for the four countries (22%). In absolute terms, the largest funding gap was reported by China (US$53 million, 88% of the total reported gap of all four countries and 24% of the total budget required by the Chinese NTP). Proportionately, the largest gap was in Cambodia (US$ 5 million, 53% of the required Cambodian NTP budget).

Notably, NTP budgets did not include costs associated with general health service and staff. For the four countries, the total cost of TB control in 2008 was estimated to be US$ 289 million (US$ 11 million for Cambodia, US$ 225 million for China, US$ 28 million for the Philippines, and US$ 25 million for Viet Nam). In 2008, TB control in China accounted for 78% of the estimated total cost in the four countries mentioned. DOTS implementation continued to account for the largest share of the NTP budgets in all four countries. The estimated gap between available funding and the total cost of TB control was US$ 60 million, equivalent to the NTP budget gap reported above. It is estimated that the overall contribution of the respective governments to the overall total cost of TB control in 2008 would be 62% (range from 27% in Cambodia to 72% in Viet Nam). The share of the total cost provided by the governments of the Philippines and China was closely related to average income levels. However, the government contributions relative to gross national income level were comparably high in Viet Nam and low in Cambodia. Global Fund will be the single most important source of external funding in Cambodia in 2008 and the country will likely rely on grant funding to fill the reported funding gap. Figure 18 shows NTP budgets by line item and key TB indicators in the four countries with a high burden of TB in the Region. In general, budgets were allocated according to the need of each line item; however, the budget for MDR-TB activities seemed too low in China and Viet Nam. The budget for first-line anti-TB drugs also seemed too low in China.

FIGuRE 17: NTP budgets, estimated total TB control cost, and sources of funding in four countries with a high burden of TB in the Region, 2002–2008

excl. = exclude; NTP = national tuberculosis control programme

24 Gross national income per capita of US$ 9266 or more .

05

1015202530

NTPbudget

Total TBcontrol

cost

NTPbudget

Total TBcontrol

cost

NTPbudget

Total TBcontrol

costPhilippines Viet Nam Cambodia

Funding gapGlobal FundGrants (excl. Global Fund)LoansGovernment (excl. loan)

0

50

100

150

200

250

NTP budget Total TBcontrol cost

China

US$

milli

on

US$ m

illion

Funding gapGlobal FundGrants (excl. Global Fund)Government (excl. loan)


5 | FINANCING TB CONTROL PROGRAMMES

FIGuRE 18: NTP budget by line item and key TB indicators in four countries with a high burden of TB in the Region, 2008

For China, the budget for programme management and supervision and for laboratory supplies and equipment was reported as a combined figure, and it was assumed the budget allocated 50% for each line item .

5.2 NTP budgets and estimated costs per patient, 2008The budget for first-line anti-TB drugs per patient ranged from US$ 19 in Viet Nam to US$ 31 in the Philippines. In 2008, it was estimated that the total cost to treat one TB patient will be under US$ 310 (Figure 19). Overall, the estimated budget for first-line anti-TB drugs per patient in 2008 decreased from -30% to -50% from 2002 in three countries (Cambodia, the Philippines, and Viet Nam) and increased only in China (+50%). The estimated budget and total cost per patient generally increased at the range of +20% to +80% compared to 2002.

FIGuRE 19: Estimated total TB control costs and national TB control programme budgets per patient in four countries with a high burden of TB, 2008

NTP = national tuberculosis control programmeNTP budgets did not include costs associated with general health service and staff .

050

100150200250300350

Philippines Viet Nam Cambodia China

U S$

First-line drugs budgetNTP budgetTotal cost

0

5

10

15

20

25

30La

b sup

plies

and e

quipm

ent b

udge

t(m

illiion

US$)

Viet Nam

China

Cambodia

Philippines

0

5

10

15

20

25

30

Prog

ramm

e man

agem

ent

and s

uper

vision

(milli

ion US

$)

0

5

10

15

20

25

30

First-

line a

nti-T

B dru

g bud

get

(milli

ion US

$)

0

5

10

15

20

25

30

35

NTP s

taff

budg

et (m

illiion

US$)

Viet Nam

Philippines

Cambodia

China

R2= 0.75

0 1 2 3 4Total TB laboratories (thousand)

R2 = 0.079

0 200 400 600 800 1000TB cases treated under DOTS (thousand)

R2= 0.047

Philippines

Viet Nam

Cambodia

China

R2= 0.033

Viet Nam

Cambodia

Philippines

China

0 100 200 300 400 500

New smear-positive cases registered (thousand)

0 200 400 600 800 1000

Total TB cases notified (thousand)


5 | FINANCING TB CONTROL PROGRAMMES

5.3 Expenditures in 2006 compared with available funding

The total combined expenditure for TB control in 2006 (reported in 2007) from the four countries was US$ 175 million: US$ 4 million for Cambodia, US$ 149 million for China, US$ 12 million for the Philippines, and US$ 10 million for Viet Nam. In general, countries in the Region successfully mobilized and spent financial resources in 2006 into case finding which could be assessed by comparing changes in expenditures from 2003–2006 with changes in the number of patients treated in the same period. All four countries spent most of the funds available to them (96% for China and the Philippines, 98% in Viet Nam, and 91% in Cambodia).


6 Profiles of countries with a high burden of TB in the Region

This section highlights epidemiologic indicators and detailed estimation of prevalence and mortality towards the 2010 goals for seven countries with a high burden of TB in the Region. Overall, these countries accounted for 94% of the regional estimated incident cases.

6.1 Cambodia

The TB control infrastructure in Cambodia is well-established; nonetheless, case detection rates in all forms of TB and smear-positive cases have not reached the 70% target. As the NTP services for TB diagnosis are decentralizing, TB control in Cambodia now faces the challenge of ensuring quality of services. Major obstacles are the limited capacity of staff at all levels, the delay in the detection of TB cases, the difficulty of ensuring free-of-charge service, and the irregularity of funds release. Despite high DOTS coverage, services are yet to reach to remote, poor and vulnerable populations.

FIGuRE 20: Cambodia

TABLE 11: Key indicators

Population (thousand) 14 197

TB burden (2006 estimate)

Incidence (all forms/100 000 population) 500

Incidence (ss+/100 000 population) 220

Prevalence (all forms/100 000 population) 665

Mortality (deaths/100 000 population) 92

Prevalence of HIV in adult incident TB cases (%) 9 .6

New multidrug-resistant TB cases (%)* 0

Previously treated multidrug-resistant TB cases (%)* 3 .1

*Surveyed in 2001.


6 | PROFILES OF COUNTRIES WITH A HIGH BURDEN OF TB IN THE REGION

TABLE 12: Surveillance and DOTS implementation (2006)

Notification rate (new and replapse/100 000 population) 244

Notification rate (new ss+/100 000 population) 136

Case detection rate (all new, %) 48

Case detection rate (new ss+, %) 62

DOTS notification rate (new and relapse/100 000 population) 244

DOTS notification rate (new ss+/100 000 population) 136

DOTS case detection (all new, %) 48

DOTS case detection (new ss+, %) 62

DOTS treatment success (2005 cohort new ss+, %) 93

Surveillance and epidemiology

Since 2000, case notification for all forms of TB and new smear-positive cases has increased significantly, at rates of +10.0% per year (95% CI, +6.4% to +13.5%) and +4.1% per year (95% CI, +0.7% to +7.5%), respectively. Similarly, case detection for all forms of TB and new smear-positive cases has increased significantly, at rates of +11.1% per year (95% CI, +7.7% to +14.6%). While overall case detection has steadily increased at a rate of +5.2% per year (95% CI, +2.2% to +8.2%) since 2000, the global and Regional target to detect 70% of the estimated new smear-positive TB cases was not reached. Case detection rates among new smear-positive TB cases dropped from 66% in 2005 to 62% in 2006. Nonetheless, the country continued to sustain its high treatment success rate (93% in 2006) among new smear-positive cases and 100% DOTS coverage.

FIGuRE 21: Trend of case notification rates (all forms of TB and smear-positive), 1990–2006

FIGuRE 22: Case notification rates by age and sex, 2006

0

50

100

150

200

250

300

199

0

199

1

199

21

993

19

941

995

199

6

199

7

199

81

999

20

00

200

1

200

22

003

200

4

200

52

006

Year

All forms (trend +10.0%/year; p<0.01)New ss+ (trend +4.1%/year; p=0.03)

Rate

s per

100 0

00po

pulat

ion

0

200

400

600

800

1000

1200

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Male

Female

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ca

ses /

100 0

00 po

pulat

ion)



TABLE 13: Trend of DOTS performance indicators

2000 2001 2002 2003 2004 2005 2006

DOTS coverage (%) 99 100 100 100 100 100 100

DOTS notification rate (new and relapse)/100 000 population) 148 147 185 209 223 253 244

DOTS notification rate (new ss+/100 000 population) 116 110 130 140 138 149 136

DOTS case detection rate (all new, %) 27 27 35 39 43 49 48

DOTS case detection rate (new ss+, %) 49 47 56 60 60 66 62

DOTS treatment success (new ss+, %) 91 92 92 93 91 93 -

DOTS re-treatment success (ss+, %) 90 92 89 87 86 76 -

Prevalence was estimated to have declined significantly at a rate of -1.6% per year since 2000 (95% CI, -2.4% to -0.9%). Given the current estimation, the prevalence would be 635 cases per 100 000 population (95% CI, 598 to 674) in 2010, if there is no acceleration in the decline in prevalence.

Mortality was estimated to have declined significantly at a rate of -4.4% per year (95% CI, -6.0% to -2.7%) since 2000. Given the current estimation, there would be 74 TB deaths (95% CI, 65 to 84) per 100 000 population, if there is no acceleration in the decline in mortality.

Estimation of MDR-TB cases

Numbers and proportions of MDR-TB cases that occurred in 2006 in new and re-treatment cases were estimated using methods described in Annex 2. In Cambodia, 0 (95% CI, 0 to 332) and 92 (95% CI, 0 to 221) MDR-TB cases were estimated to have occurred in new and re-treatment TB cases, respectively. The prevalence of MDR-TB was 0% (95% CI, 0% to 0.5%) and 3.1% (95% CI, 0.6% to 8.9%) in new and re-treatment cases, respectively.



6.2 China

Challenges to TB control in China are related to rapid expansion of DOTS coverage and laboratory capacity. The major issue faced by the Chinese NTP is the insufficiency of skilled medical personnel to implement DOTS and ensure EQA of sputum microscopy. Alarming rates of MDR-TB in several provinces have given China the world’s largest MDR-TB epidemic. But China has the largest budget of MDR-TB globally. Further complicating matters, the HIV epidemic is highly heterogeneous. It is low-level in most areas of the country. However, there are pockets of higher prevalence, particularly in the western and southern provinces. The HIV epidemic in China may move from high-risk groups into the general population; preliminary reports suggest that HIV-associated TB is already a serious problem in several counties. In many cities and municipalities, the historical decline in TB notification has been reversed in recent years because of the increase in TB cases among the internal migrant labour population.

FIGuRE 23: China


Population (thousand) 1 320 864







New multidrug-resistant TB cases (%)* 0 .9-10 .4

Previously treated multidrug-resistant TB cases (%)* 8 .0-41 .9

*Depending on locations (surveyed in 1997 through 2005) .














Since 2000, case notification for all forms of TB and new smear-positive cases has increased significantly at rates of +13.5% per year (95% CI, +8.5% to +18.5%) and +16.5% per year (95% CI, +9.1% to +24.0%), respectively. Case detection for all forms and for new smear-positive cases have also increased significantly at rates of +20.2% per year (95% CI, +14.7 to +25.7%) and +19.4% per year (95% CI, +11.4% to +27.4%), respectively. The country has sustained 100% DOTS coverage since it reached the target in 2005. Case detection and treatment success rates among new smear-positive cases have been remarkably high, reporting at 79% and 94%, respectively, in 2006.




2000 2001 2002 2003 2004 2005 2006

DOTS coverage (%) 68 68 78 91 96 100 100

DOTS notification rate (new and relapse/100 000 population) 27 28 30 43 58 68 71






199

0

199

1

199

21

993

19

941

995

199

6

199

7

199

81

999

20

00

200

1

200

22

003

200

4

200

52

006

Year

Rate

s per

100 0

00po

pulat

ion

01020304050607080

All forms (trend +13.5%/year; p<0.01)New ss+ (trend +16.5%/year; p<0.01)

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Male

Female

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ca

ses /

100 0

00 po

pulat

ion)

0

20

40

60

80

100

120

140

160



Prevalence was estimated to have changed at a rate of -3.2% per year since 2000 (95% CI, -7.9% to +1.5%). Given the current estimation, the prevalence would be 184 per 100 000 population (95% CI, 127 to 266) in 2010, if there is no acceleration in the decline in prevalence.

Mortality was estimated to have declined significantly at a rate of -4.7% per year since 2000 (95% CI, -5.8% to -3.7%). Given the current estimation, there would be 13 TB deaths per 100 000 population (95% CI, 12 to 14) in 2010, if there is no acceleration in the decline in mortality.


The total number of MDR-TB cases from China accounted for 85% of the total estimated MDR-TB cases in the Region. Nearly 66 000 MDR-TB cases (65 853 cases; 95% CI, 41 883 to 90 663) were estimated to have occurred in new TB cases in 2006. Among re-treatment cases, there were 64 694 estimated MDR-TB cases (95% CI, 41 304 to 88 232). Proportionately, the prevalence of MDR-TB in new and re-treatment cases was 5% (95% CI, 4.6% to 5.5%) and 25.6% (95% CI, 23.7% to 27.5%), respectively.



6.3 The Lao People’s Democratic Republic

The mountainous geography and the low population density in many areas pose challenges to TB control activities in the Lao People’s Democratic Republic, increasing the difficulty in communication, monitoring, and distribution of supplies and equipment. Staff in remote provinces and districts often receive limited support and have fewer resources for TB diagnosis, resulting in a high turn-over of personnel. TB cases residing in distant villages have limited access to the district hospital due to distance and costs of transportation. Increased involvement of the private sector in TB control activities is expected due to economic progress in Vientiane and large provincial capitals.

FIGuRE 26: The Lao People’s Democratic Republic


Population (thousand) 5759







New multidrug-resistant TB cases (%) -

Previously treated multidrug-resistant TB cases (%) -














Since 2000, case notification for all forms of TB and new smear-positive cases has increased significantly, at rates of +8.5% per year (95% CI, +6.3% to +10.6%) and +10.9% per year (95% CI, +7.6% to +14.2%), respectively. Correspondingly, case detection for all forms of TB and new smear-positive cases has increased significantly at rates of +14.8% per year (95% CI, +10.7 to +19.1%) and +11.4% per year (95% CI, +8.0% to +14.9%), respectively. The country reached 100% DOTS coverage target in 2005 and has sustained at this level in 2006. Case detection and treatment success rates among new smear-positive cases were 77% and 90%, respectively, in 2006.




2000 2001 2002 2003 2004 2005 2006

DOTS coverage (%) 70 75 77 85 98 100 100







Prevalence was estimated to have declined significantly at a rate of -2 .6% per year since 2000 (95% CI, -3 .2% to -2 .1%) . Given the current estimation, the prevalence would be 271 per 100 000 population (95% CI, 256 to 279) in 2010, if there is no acceleration in the decline in prevalence .

199

0

199

1

199

21

993

19

941

995

199

6

199

7

199

81

999

20

00

200

1

200

22

003

200

4

200

52

006

Year

Rate

s per

100 0

00po

pulat

ion

01020304050607080

All forms (trend +8.5%/year; p<0.01)New ss+ (trend +10.9%/year; p<0.01)

0

50

100

150

200

250

300

350

400

450

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Male

Female

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ca

ses /

100 0

00 po

pulat

ion)



Mortality was estimated to have declined at a rate of -3.7% per year since 2000 (95% CI, -4.9% to -2.5%). Given the current estimation, there would be 20 TB deaths per 100 000 population (95% CI, 18 to 22) in 2010, if there is no acceleration in the decline in mortality.


Some 322 (95% CI, 46 to 1791) estimated MDR-TB cases occurred among new TB cases and 76 (95% CI, 16 to 241) estimated MDR-TB cases occurred among re-treatment cases in the Lao People’s Democratic Republic in 2006. These numbers correspond to 3.7% (95% CI, 0.6% to 19.9%) and 19.4% (95% CI, 4.0 to 58.1%) of the new and re-treatment cases, respectively.



6.4 Mongolia

Major challenges in TB control activities in Mongolia include the distances between health facilities and communities, and the poverty characterizing many TB cases. Most TB cases receive the first two months of treatment in hospital while the continuation phase is completed on an ambulatory basis. Prisoners, the homeless, and unemployed persons are identified as vulnerable groups for TB; treatment success rates among these populations are lower compared to the general population. MDR-TB is a continuing challenge to TB control in Mongolia, especially among prisoners.

FIGuRE 29: Mongolia









New multidrug-resistant TB cases (%)* 1 .4

Previously treated multidrug-resistant TB cases (%) 27 .5

*2008 Survey preliminary data














Since 2000, case notification for all forms of TB and for new smear-positive cases has significantly increased at a rate of +6.8% per year (95% CI, +5.3% to +8.4%) for both categories. Case detection for all forms of TB and for new smear-positive cases has significantly increased at rates of +8.0% per year (95% CI, +5.1% to +11.0%) and +6.9% per year (95% CI, +3.2% to +10.7%), respectively. The country has maintained 100% DOTS coverage for the past eight consecutive years including 2006. The treatment success rate in new smear-positive cases was noted at 88%.




2000 2001 2002 2003 2004 2005 2006

DOTS coverage (%) 100 100 100 100 100 100 100







Prevalence was estimated to have significantly declined at a rate of -6.3% per year since 2000 (95% CI, -7.5% to -5.0%). It was estimated that the prevalence would be 147 per 100 000 population (95% CI, 134 to 162) in 2010, if there is no acceleration in the decline in prevalence.

0

50

100

150

200

250

199

0

199

1

199

21

993

19

941

995

199

6

199

7

199

81

999

20

00

200

1

200

22

003

200

4

200

52

006

Year

Rate

s per

100 0

00po

pulat

ion

All forms (trend +6.8%/year; p<0.01)New ss+ (trend +6.8%/year; p=0.01)

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Male

Female

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ca

ses /

100 0

00 po

pulat

ion)

0

20

40

60

80

100

120

140

160



Mortality was estimated to have significantly declined at a rate of -12.3% per year since 2000 (95% CI, -18.4% to -6.2%). Given the current estimation, there would be 11 TB deaths per 100 000 population (95% CI, 7 to 17) in 2010.


It was estimated that there were 48 (95% CI, 9 to 107) MDR-TB cases among new TB cases and 68 (95% CI, 13 to 204) MDR-TB cases among re-treatment cases. Proportionately, there were 1.0% (95% CI, 0.3% to 2.5%) of MDR-TB in new TB cases and 20.5% (95% CI, 4.3% to 59.6%) of MDR-TB in re-treatment cases.



6.5 Papua New Guinea

The Government and churches provide nearly 100% of health care services in Papua New Guinea. Churches alone run 46% of health facilities, particularly those that are located in the periphery, using funds provided by the national government. Major challenges in TB control in Papua New Guinea include the limited availability of resources and staff, affecting implementation of TB control activities. Due to previous years’ low performance of TB control in the country, incidence of MDR-TB is likely to be rising, as noted by anecdotal reports of the increased number of MDR-TB cases identified by Australian TB services across the Torres Strait. Recording and reporting remain incomplete.

FIGuRE 32: Papua New Guinea








Prevalence of HIV in adult incident TB cases (%) 4

New multidrug-resistant TB cases (%) -

Previously treated multidrug-resistant TB cases (%) -














From 2000 through 2006, case notification in Papua New Guinea has been relatively stable (0% change per year; 95% CI, -3.1% to 3.1% for all forms of TB and +1.0% change per year; 95% CI, -9.1% to +11.1% for new smear-positive cases). In contrast, case detection for all forms of TB and new smear-positive has significantly increased at rates of +17.3% per year (95% CI, +7.3% to +27.3%) and +18.7% per year (95% CI, +10.8% to +26.5%), respectively. DOTS coverage dropped from 53% of earlier year to 40% in 2006. While the case detection rate in new smear-positive cases has been stable at 21% between 2005 and 2006, the treatment success rate has increased from 65% in 2005 to 71% in 2006.




2000 2001 2002 2003 2004 2005 2006

DOTS coverage (%) 8 13 24 46 47 53 40







0

50

100

150

200

250

300

199

0

199

1

199

21

993

19

941

995

199

6

199

7

199

81

999

20

00

200

1

200

22

003

200

4

200

52

006

Year

Rate

s per

100 0

00po

pulat

ion All forms (trend +0%/year; p=1.00)New ss+ (trend +1%/year; p=0.84)

0

10

20

30

40

50

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Male

Female

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ca

ses /

100 0

00 po

pulat

ion)



Prevalence was estimated to have declined significantly at a rate of -5.2% per year (95% CI, -9.1% to -1.3%) from 2000 through 2004. However, there was a significant increase in prevalence starting from 2004 (+6.8%; 95% CI, +0.01 to +13.5%). Given the current overall exponential decline rate of -5.2% per year, the prevalence would be 377 per 100 000 population (95% CI, 277 to 511) in 2010; however, the trend may subject to change.

O veral l , mor ta l i t y has decl ined s igni f icant ly at a rate of -4 .6% (95% CI , -8 .2% to -0.9%) per year from 2000 through 2004. From 2004, however, there was an increase in deaths at a rate of +6.7% per year (95% CI, -11.1% to +24.4%). Given the current overall exponential decline rate of -4.4% per year, there would be 37 TB deaths per 100 000 population (95% CI, 28 to 49) in 2010; however, the trend may subject to change.

Estimation of MDR-TB casesOverall, more than 900 MDR-TB were estimated to have occurred in Papua New Guinea in 2006, including 563 (95% CI, 82 to 3 142) cases among new TB cases and 352 (95% CI, 66 to 1092) cases among re-treatment cases. Proportionately, there were 3.6% (95% CI, 0.6 to 20.0%) and 19.5% (95% CI, 4.1% to 58.6%) of MDR-TB in new and re-treatment cases, respectively.



6.6 The Philippines

The Philippines has developed great infrastructure for TB control activities. Collaborative efforts between public and private sectors and the establishment of TB diagnostic committees have successfully contributed to a dramatic increase in case detection, and decline in the number of over-diagnosis of smear-negative cases. Efforts are being made to build on the existing system to mainstream programmatic management of MDR-TB activities.

FIGuRE 35: The Philippines









New multidrug-resistant TB cases (%)* 4


*Surveyed in 2004 .














Since 2000, case notification for all forms of TB has not changed significantly at a rate of +2.3% per year (95% CI, -0.4% to +4.9%), while new smear-positive case notification has significantly increased at a rate of +3.5% per year (95% CI, +0.5% to +6.5%). Case detection for all forms of TB and new smear-positive cases has significantly increased at rates of +5.9% per year (95% CI, +3.0% to +8.9%) and +7.6% per year (95% CI, +5.1% to +10.1%), respectively. DOTS coverage has been sustained at 100% for four consecutive years including 2006. In these four years, the country has achieved and maintained high case detection and treatment success rates among new smear-positive cases above the 70% and 85% targets, respectively.




2000 2001 2002 2003 2004 2005 2006

DOTS coverage (%) 90 95 98 100 100 100 100






DOTS re-treatment success (ss+, %) - - - 76 53 - -

0

100

200

300

400

500

600

199

0

199

1

199

21

993

19

941

995

199

6

199

7

199

81

999

20

00

200

1

200

22

003

200

4

200

52

006

Year

Rate

s per

100 0

00po

pulat

ion

All forms (trend +2.3%/year; p=0.08)New ss+ (trend +3.5%/year; p=0.03)

0

50

100

150

200

250

300

350

400

450

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Male

Female

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ca

ses /

100 0

00 po

pulat

ion)



Prevalence was estimated to have decreased significantly at a rate of -3.9% per year since 2000 (95% CI, -4.9% to -2.8%). Given the current estimation, the prevalence would be 366 per 100 000 population (95% CI, 337 to 340) in 2010, if there is no acceleration in the decline in prevalence.

Mortality was estimated to have decreased significantly at a rate of -4.0% per year since 2000 (95% CI, -4.9% to -3.1%). Given the current estimation, there would be 38 TB deaths per 100 000 population (95% CI, 36 to 41) in 2010, if there is no acceleration in the decline in mortality.


The estimated total MDR-TB cases from the Philippines, ranking the second highest in the Region, accounted for 9% of the overall MDR-TB cases: 10 012 (95% CI, 5676 to 15 135) cases among new TB cases and 1836 (95% CI, 1007 to 2810) cases among re-treatment cases. Prevalence of MDR-TB was estimated at 4.0% (95% CI, 2.9% to 5.5%) for new TB cases and 20.9% (95% CI, 14.3% to 29.0%) for re-treatment cases.



6.7 Viet Nam

Challenges faced by TB control activities in Viet Nam are related to the rapid spread of HIV since the early 1990s. The ongoing spread of the HIV epidemic is expected to exacerbate the number of TB cases. However, high political commitment at all levels supports national strategies to respond to the increasing number of TB-HIV cases. A TB control network with trained staff has been established nationwide within the last decade. However, access barriers to DOTS facilities remain in Viet Nam (e.g., distances, language, and stigma). Vulnerable populations include the indigent, ethnic minorities, prisoners, persons detained at drug rehabilitation centres, PLWHA, and IDUs. Treatment is not yet available for MDR-TB cases.

FIGuRE 38: Viet Nam








Prevalence of HIV in adult incident TB cases (%) 5

New multidrug-resistant TB cases (%)* 2 .7


*Surveyed in 2006 .














Since 2000, case notification for all forms of TB and new smear-positive cases has remained unchanged: -0.02% per year (95% CI, -1.1% to +0.8%) and -0.6% per year (95% CI, -2.1% to +0.8%), respectively. Nonetheless, a prevalence survey conducted recently by the NTP showed a higher prevalence rate than previously estimated, indicating that many TB cases may go un-notified. Case detection has also changed non-significantly at rates of +0.7% per year (95% CI, -0.1% to +1.6%) for all forms of TB and +0.4% per year (95% CI, -1.0% to +1.8%) for new smear-positive cases. However, the country has sustained 100% DOTS coverage, high case detection and treatment success rates in new smear-positive cases 2000–2006.




2000 2001 2002 2003 2004 2005 2006

DOTS coverage (%) 100 100 100 100 100 100 100







0

20

40

60

80

100

120

140

199

0

199

1

199

21

993

19

941

995

199

6

199

7

199

81

999

20

00

200

1

200

22

003

200

4

200

52

006

Year

Rate

s per

100 0

00po

pulat

ion

All forms (trend -0.2%/year; p=0.70)New ss+ (trend -0.6%/year; p=0.31)

0

50

100

150

200

250

300

350

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Male

Female

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ca

ses /

100 0

00 po

pulat

ion)



Prevalence was estimated to have significantly declined at a rate of -1.3% per year since 2000 (95% CI, -1.2% to -0.5%). Given the current estimation, the prevalence would be 219 per 100 000 population (95% CI, 207 to 231) in 2010, if there is no acceleration in the decline in prevalence.

Mortality was estimated to have declined significantly at a rate of -1.1% per year since 2000 (95% CI, -2.4% to -0.3%). Given the current estimation, there would be 22 TB deaths per 100 000 population (95% CI, 20 to 24) in 2010, if there is no acceleration in the decline in mortality.


The total number of MDR-TB cases in Viet Nam ranked the third highest in the Region (4% of regional MDR-TB cases). There were 4047 (95% CI, 2341 to 6056) and 2374 (95% CI, 1378 to 3535) estimated MDR-TB cases among new TB and re-treatment cases, respectively. The prevalence of MDR-TB in new TB cases was 2.7% (95% CI, 2.0% to 3.6%), while that of re-treatment cases was 19.3% (95% CI, 14.2% to 25.4%).


7 Summary of the TB burden and epidemiologic indicators of countries and areas with an intermediate burden of TB in the Region

7.1 Estimated burden and trend towards 2010 goals

Among the seven countries and areas with an intermediate burden of TB—Brunei Darussalam, Hong Kong (China), Japan, Macao (China), Malaysia, the Republic of Korea, and Singapore—the prevalence was highest in Malaysia (125 per 100 000 population) and lowest in Singapore (25 per 100 000 population) (Figure 41). In 2006, there were an estimated 103 727 new TB cases in these countries and areas, representing 5.4% of the total TB cases in the Region. Incidence rates were highest in Malaysia (103 per 100 000 population) and lowest in Japan (22 per 100 000 population). A total of 13 334 TB cases were estimated to have died (4.6% of total deaths). Mortality rates were highest in Malaysia (17 per 100 000 population) and lowest in Singapore (2 per 100 000 population). Estimated prevalence and mortality in 2010 and goals to halve the prevalence and mortality rates of 2000 in countries or areas with an intermediate burden of TB in the Region is shown in Table 32.

FIGuRE 41: Prevalence, incidence, and mortality rates per 100 000 population in countries and areas with an intermediate burden of TB in the Region, 2006

0

20

40

60

80

100

120

140

Prevalence Incidence Death

Brun

eiDa

russa

lam

Hong

Kong

(China

)

Maca

o(Ch

ina)

Japa

n

Malay

sia

Repu

blic

of Ko

rea

Singa

pore

Rate

per 1

00 00

0 pop

ulatio

n


7 | SUMMARY OF THE TB BURDEN AND EPIDEMIOLOGIC INDICATORS OF COUNTRIES AND AREAS WITH AN INTERMEDIATE BURDEN OF TB IN THE REGION

TABLE 32: Estimated prevalence and mortality in 2010 and goals to halve the prevalence and mortality rates of 2000 in countries or areas with an intermediate burden of TB in the Region

Country and area

Prevalence rate Mortality rate


Estimate in 2010* Goal in 2010†


Estimate in 2010* Goal in 2010†

Brunei Darussalam +7 .0% § 28 -10 .1% § 2

Hong Kong (China) -4 .2% 58 44 -4 .8% 4 4

Japan -6 .0% 26 23 -3 .1% 3 2

Macao (China) -4 .2% 61 44 -32 .1% 1 4

Malaysia -1 .6% 120 70 -0 .4% 16 8

Republic of Korea -2 .0% 115 71 -2 .7% 9 6

Singapore -6 .8% 21 20 -9 .2% 2 2a Average from 2000 through 2006*Per 100 000 population, assuming current rate of change.† Per 100 000 population.§Estimates unreliable due to high proportion of TB among foreign migrant labourers.

7.2 Case notification and trends

Across the intermediate burden countries and areas, 86 462 TB cases (all forms) were notified in 2006, including 33 443 smear-positive cases. The largest number of smear-positive cases were reported from the Republic of Korea (11 513 cases), followed by Japan (10 159 cases), Malaysia (9414 cases). Case notification rates have been declining in these countries and areas since the 1980s (Figure 42). However, in Brunei Darussalam and Macao (China), the rates have been fluctuating because of migration and smaller populations. The rate of decline is small (1%/year) but stable in Malaysia.

FIGuRE 42: Case notification rates of all forms of TB in countries and areas with an intermediate TB burden in the Region, 1990–2006

0

50

100

150

200

250

300

350

400

450

500

1980 1985 1990 1995 2000 2005

year

Brunei Darussalam

Hong Kong, China

Japan

Macao, China

Malaysia

Republic of Korea

Singapore

rate

/ 100

0 000

popu

lation



Similar to the pattern seen in the countries with a high burden of TB, TB disproportionately affected males and older people (Figure 43). For every female smear-positive TB case older than 14 years, 1.5 to 3.2 male smear-positive TB cases were notified. In children younger than 15 years however, equal numbers of each sex were notified.

FIGuRE 43: Smear-positive notification rates, by age and sex, in countries and areas with an intermediate burden of TB, 2006

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ar

ea / 1

00 00

0 pop

ulatio

n)

Brunei Darussalam

MenWomen

020406080

100120140160180200

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ar

ea / 1

00 00

0 pop

ulatio

n)Hong Kong (China)

MenWomen

0

20

40

60

80

100

120

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ar

ea / 1

00 00

0 pop

ulatio

n)

Macao (China)

MenWomen

0

20

40

60

80

100

120

140

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ar

ea / 1

00 00

0 pop

ulatio

n)

Japan

MenWomen

0

5

10

15

20

25

30

35

40

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ar

ea / 1

00 00

0 pop

ulatio

n)

Malaysia

MenWomen

0

20

40

60

80

100

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ar

ea / 1

00 00

0 pop

ulatio

n)

Republic of Korea

MenWomen

0

20

40

60

80

100

0–14 15–24 25–34 35–44 45–54 55–64 65+

Age group (yrs)

Notif

icatio

n rat

e (DO

TS an

dno

n-DO

TS ar

ea / 1

00 00

0 pop

ulatio

n)

Singapore

MenWomen

0

10

20

30

40

50

60

70



7.3 Drug resistance

As of 2006, all countries with an intermediate burden of TB except Brunei Darussalam have conducted DRS. The prevalence of resistance to the first line anti-TB drugs are generally low in these countries and areas, except in Macao (China) and the Republic of Korea (Table 33).

The proportion of extensively drug-resistant TB (XDR-TB) among MDR-TB strains tested was 31% in Japan, followed by 15% in Hong Kong (China).

TABLE 33: Anti-TB drug resistance surveys in countries and areas with an intermediate burden of TB, 2002–2005 .

Country and area Year

New cases Re-treatment cases

# of strains tested

INH resistance (%)

MDR-TB(%)

# of strains tested

MDR-TB(%)

Hong Kong (China) 2005 3271 5 .0 0 .9 163 8 .0

Macao (China) 2005 265 10 .6 2 .3 19 15 .8

Japan 2002 2474 2 .8 0 .7 417 9 .8

Republic of Korea 2004 2636 9 .9 2 .7 278 14 .0

Singapore 2004 895 3 .4 0 .2 105 1 .0

# = number; INH = isoniazid; MDR-TB = multidrug-resistance tuberculosis; Malaysia's data was not listed because the DRS was conducted before 2000.

Using data from the Global Project on Anti-tuberculosis Drug Resistance Surveillance, the numbers and proportions of MDR-TB cases in new and re-treatment cases estimated to have occurred by country and area in 2006 were calculated (see method in Annex 2). Across the seven countries and areas with an intermediate burden of TB, there were 1421 (95% CI, 808 to 2201) estimated MDR-TB among new cases, corresponding to 1.4% (95% CI, 0.8% to 2.1%) of 103 727 estimated new cases. It was estimated that 1224 (95% CI, 695 to 2138) MDR-TB cases occurred, corresponding to 11.0% (95% CI, 6.2% to 19.1%) of the estimated 11 167 re-treatment cases in the seven countries and areas with an intermediate burden of TB in 2006. The 1421 MDR-TB cases from the seven countries and areas with intermediate burden of TB represented 1.7% of the total MDR-TB cases estimated to have occurred among new TB cases across the Region; likewise, the 1224 MDR-TB cases also represented 1.7% of the total MDR-TB cases estimated to have occurred among re-treatment TB cases across the Region.

7.4 TB-HIV

The estimated HIV prevalence among new TB cases in Malaysia (11.0%) and Brunei Darussalam (8.9%) ranked the highest and the second-highest across the Region. According to the sentinel surveillance data which were collected from four countries and areas with an intermediate burden of TB—Brunei Darussalam, Hong Kong (China), Macao (China), and Malaysia—the proportion of TB cases tested for HIV was high: 82.6% of the total notified TB cases. Of 18 150 TB cases tested, 1477 were identified as HIV-infected, representing 8.7% of the total of the tested cases. Of the four countries and areas, only two [Hong Kong (China) and Macao (China)] had provided data on CPT and ART among TB-HIV cases. Of the 33 TB-HIV cases in Hong Kong (China), 19 and 15 were on CPT and ART, respectively. Of the five TB-HIV co-infected cases in Macao (China), none was on CPT, and two were on ART.



7.5 Treatment outcomes

O f the seven countr ies and areas with an intermediate burden of TB, there were 25 068 new smear-positive cases registered for TB treatment in 2005. Treatment success rate was highest in Macao (China) (93%) (Figure 44).

FIGuRE 44: Treatment outcomes for new smear-positive cases registered in 2005 in DOTS areas in countries and areas with an intermediate burden of TB in the Region

Numbers in bars show percentages of treatment success outcome .

In Macao (China) and Singapore, death accounted for more than 50% of unfavourable treatment outcomes (Figure 45). The largest proportions of unfavourable treatment outcomes in Brunei Darussalam and the Republic of Korea were attributable to transfer-out cases. In Brunei Darussalam, many TB cases occur among migrant workers who return to their country of origin after they become sputum smear-negative for the continuation phase of the treatment. In Japan, the proportion of patients with treatment completed (as opposed to cured) is high because sputum examinations may not be conducted at the end of treatment. About 26% of cases were not evaluated due to incomplete reporting from physicians to peripheral health offices.

FIGuRE 45: Unfavourable outcomes among new smear-positive cases registered in 2005 in DOTS areas in countries and areas with an intermediate burden of TB in the Region

7.6 Laboratory services

As of 2006, 515 smear microscopy laboratories were established in the seven countries with an intermediate burden of TB. The total number of smear microscopy laboratories accredited by EQA was unknown due to unavailable data. Of the 515 laboratories, 16 were reported to be capable of performing DST.

71 77 93 60 70 83 83

0%

20%

40%

60%

80%

100%

OthersFailureDeathSuccess

Brun

eiDa

russa

lam

Hong

Kong

(Chin

a)

Maca

o(Ch

ina)

Japa

n

Malay

sia

Repu

blic

of Ko

rea

Singa

pore

Treat

men

t out

com

es

0%

20%

40%

60%

80%

100%Not evaluated

Transfer out

Default

Failure

Death

Brun

eiDa

russa

lam

Hong

Kong

(China

)Ma

cao

(China

)

Japa

n

Malay

sia

Repu

blic

of Ko

rea

Singa

pore

Treat

ment

outco

mes


8 Summary of the TB burden and epidemiologic indicators of Pacific island countries and areas in the Region

FIGuRE 46: Geographic distribution of the Pacific island countries and areas and their grouping (and see Table 34) .

Vanuatu

Solomon Islands

Marshall IslandsGuam

Palau Micronesia

Kiribati

Tuvalu

Tonga

Niue

Tokelau

Guam

Palau Micronesia

Kiribati

TongaWallis and Futuna

Niue

Northern Mariana Islands

French PolynesiaFrench PolynesiaAmerican SamoaAmerican Samoa

Cook IslandsCook IslandsFijiFijiNew CaledoniaNew Caledonia

Vanuatu

Solomon IslandsTuvalu SamoaSamoa

Tokelau

Chamorro group

Polynesia groupMelanesia group

Micronesia group

The boundaries shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries .

© WHO 2005. All rights reserved

The Pacif ic is land countr ies and areas include American Samoa, Cook Is lands, Fi j i , French Polynesia, Guam, Kiribati, Northern Mariana Islands, Marshall Islands, Micronesia, Nauru, New Caledonia, Niue, Palau, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, and Wallis and Futuna (Figure 46). Table 34 shows the key indicators of TB control in the Pacific island countries and areas. Prevalence ranged from 12 per 100 000 population in American Samoa to 504 per 100 000 population in Tuvalu. There were estimated 1249 new TB cases in the Pacific island countries and areas, representing 0.06% of the total TB cases in the Region. Incidence rates were highest in Kiribati (372 per 100 000 population) and lowest in American Samoa (9 per 100 000 population). A total of 163 TB cases were estimated to have died (0.06% of the total deaths in the Region). The mortality rate was highest in Tuvalu (55 per 100 000 population) and lowest in American Samoa (1 per 100 000 population).

Case notification rates vary across the Pacific island countries and areas (Figure 47). Fluctuation of the rates over time is due to the small population sizes of those countries and areas. High notification rates were observed in Kiribati: over 300 cases per 100 000 population in the past several years. A consistent and significant decline in case notification rates both for all forms of TB and smear-


8 | SUMMARY OF THE TB BURDEN AND EPIDEMIOLOGIC INDICATORS OF PACIFIC ISLAND COUNTRIES AND AREAS IN THE REGION

positive cases was observed in the Northern Mariana Islands (trend -7.2% per year; 95% CI, -14.2% to -0.2% for all forms of TB, trend -12.5%; 95% CI, -18.7% to -6.2% for smear-positive cases) and New Caledonia (-11.2% per year; 95% CI, -22.1% to -0.4% for all forms of TB, trend -11.4% per year; 95% CI, -22.2% to -0.5% for smear-positive cases).

Among the four groups of the Pacific island countries and areas (see the grouping in Table 34), the incidence rate has steadily declined in Polynesia and Melanesia groups, while it has started climbing up in the Micronesia group in 1999.

TABLE 34: Key indicators of TB control in the Pacific island countries and areas in the Region, 2006

Country and area Population

Estimated incidenceCase detection

rateTrend of notification

rateEst.

Preva-lence rate

Est. mor-talityRateRate Number (%) (% per year)

All ss+ All ss+ All ss+ All ss+ All All

Chamorro group

Guam 171 000 37 17 64 29 69 73 -4 .0 -14 .9* 49 6

Northern Mariana Islands 82 128 75 34 61 28 83 54 -7 .2* -12 .5* 90 10

Micronesia group

Kiribati 93 553 372 168 348 157 107 82 +8 .2 +14 .3 402 45

Marshall Islands 57 962 220 99 127 57 101 79 +21 .1* +24 .6* 241 28

Micronesia 110 617 101 45 112 50 90 82 +0 .1 +22 .2* 109 12

Nauru 10 130 106 48 11 5 112 42 +22 .0* -9 .8 134 15

Palau 20 225 51 23 10 5 116 129 +2 .1 -13 .7 51 4

Polynesia group

American Samoa 65 458 9 4 6 3 69 115 +9 .7 +7 .5 12 1

Cook Islands 13 641 16 7 2 1 47 0 -2 .8 -12 .4 24 3

French Polynesia 259 247 26 12 68 31 98 78 -0 .2 0 29 3

Niue 1 597 43 19 1 0 0 0 - - 85 9

Samoa 185 366 19 9 36 16 64 80 -5 .6 -2 .2 25 3

Tokelau 1 391 56 25 1 0 0 0 - - 112 12

Tonga 99 811 25 11 24 11 74 127 -3 .3 +2 .2 34 3

Tuvalu 10 486 295 133 31 14 29 29 -8 .5 - 504 55

Wallis and Futuna 15 153 46 21 7 3 - - +31 .1 +5 .4 60 7

Melanesia group

Fiji 833 330 22 10 184 83 61 88 -5 .7 -0 .1 30 3

New Caledonia 237 950 27 12 63 28 65 32 -11 .2* -11 .4* 35 4

Solomon Islands 484 022 135 61 655 295 56 42 +3 .0 +2 .8 194 23

Vanuatu 220 772 58 26 128 58 98 73 -10 .1 -8 .8 65 8

Incidence rate, prevalence rate, mortality rate are per 100 000 population.All = all forms; est. = estimated; Pop. = population; ss+ = smear-positive; - = could not be calculated because of lack of data or data were not reliable; * = statistical significance.

Grouping of the Pacific island countries and areas was used to compare TB epidemiological patterns . Group names were selected based on convenience criteria only . This classification does not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, or area or of its authorities .



FIGuRE 47: Case notification rates (all forms of TB and smear-positive cases) in the Pacific island countries and areas in the Region, 2006

Panels A, B, C: smoothed lines using moving average method.

A. Chamorro group

B. Micronesia group

C. Polynesia group 25

25 In Tokelau, no case was notified since 1995, so the chart is not shown here .

01020304050607080

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Chamorro group19

9319

9419

9519

9619

9719

9819

9920

0020

0120

0220

0320

0420

0520

06

rate

per 1

00 00

0 pop

ulatio

n

GuamData are missing for 1995-99.

010203040506070

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n


020406080

100120140160

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Micronesia group

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Kiribati19

93

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Marshall IslandsData are missing for 1994–5 and 1997.

0

50

100

150

200

250

0

100

200

300

400

500

600

700

0

50

100

150

200

250

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Micronesia (Federated States of)Data are missing for 1999.

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

NauruData is missing for 1995–98, 2004.

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

PalauData are missing for 1998, and 2000–1.

020406080

100120140160180

0

20

40

60

80

100

120

140

0

50

100

150

200

250

300

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Polynesia group

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

American Samoa

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Cook Islands

05

10152025303540

02468

1012

05

1015202530

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

French Polynesia

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Niue

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Samoa

05

101520253035404550

050

100150200250

05

101520253035



D. Melanesia group

Figure 48 shows TB notification rates are higher in countries and areas with lower per capita gross domestic product (GDP). Higher notification rates are observed in countries of Micronesia group and in Tuvalu, where overcrowding is common.

FIGuRE 48: TB notification rates and gross domestic product in Pacific island countries and areas in the Region, 2000–2006

GDP = gross domestic product Case notification rates were the average rates of 2000–2006 .

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Tonga

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

TuvaluData is unavailable for 1996–97 and 2004.

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Wallis and FutunaData is unavailable for 1998–2000, 2004 and 2006.

05

10152025303540

050

100150200250300350400

0

20

40

60

80

100

120

14019

9319

9419

9519

9619

9719

9819

9920

0020

0120

0220

0320

0420

0520

06

rate

per 1

00 00

0 pop

ulatio

n

Melanesia group

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Fiji

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

New Caledonia

0102030405060

05

101520253035

0102030405060

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Solomon Islands

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

rate

per 1

00 00

0 pop

ulatio

n

Vanuatu

020406080

100120

020406080

100120

R 2 = 0.31

2.8

3.0

3.2

3.4

3.6

3.8

4.0

4.2

4.4

0 50 100 150 200 250 300 350

MicronesiaTuvalu Kiribati

Marshall Islands

Northern Mariana IslandsGuam

New Caledonia

French Polynesia

2.8

3.0

3.2

3.4

3.6

3.8

4.0

4.2

4.4

0 50 100 150 200 250 300 350

Case notification rate (all TB forms) per 100 000 population

Log1

0 GDP

per c

apita

Tuvalu


8 | ANNEXES

Annexes

Annex 1: Estimation of prevalence and TB mortality rates for future years

A linear regression model for each country and area was fitted on log-transformed TB prevalence data that were collected annually from the respective countries and areas:

with r the prevalence rate per 100 000 population and t expressed in years. The slope 1 can be interpreted as a constant rate of change per year assuming an exponential decline of the un-transformed prevalence rate. To estimate numbers of prevalent cases in future years for which data were not yet available, predicted values of prevalence rates and their respective 95% confidence intervals were estimated. For the estimation of mortality rates in future years, a linear regression model was fitted as above by substituting prevalence rates with TB mortality rates.

tr 10)ln(


8 | ANNEXES

Annex 2: Estimation of MDR-TB prevalence

Based on drug resistance data reported from 114 countries and two special administrative regions of China, logistic regression models were fitted to estimate the proportion of MDR-TB among new, previously treated, and combined TB cases for a further 69 countries for which surveyed data were not available. The estimated number of new TB cases by country and area was used to calculate the number of MDR-TB cases that occurred among new cases. To estimate the number of previously treated cases for each country and area the ratio of notified re-treatment cases to notified new cases in 2006 was multiplied by the total number of new cases estimated to have occurred in the same year; therefore, the total number of estimated cases included estimated re-treatment cases.

The method and models were described in detail in:

Zignol M et al. Global Incidence of Multidrug-resistant Tuberculosis. Journal of Infectious Diseases, 2006, 194:479-85; and

The WHO/IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance. Anti-Tuberculosis Drug Resistance in the World. Fourth Global Report. Geneva, World Health Organization, 2008 (WHO/HTM/TB//2008.394).


8 | ANNEXES

Annex 3: Definitions

1. Definitions of tuberculosis cases

A case of tuberculosis: A patient in whom tuberculosis (TB) has been bacteriologically confirmed or has been diagnosed by a clinician. Any person given treatment for TB should be recorded.

All forms: The sum of new smear-positive pulmonary, relapse, new smear-negative pulmonary and extrapulmonary cases.

New smear-positive pulmonary TB: 26 A patient who has never received treatment for TB, or who has taken anti-TB drugs for less than 30 days and who has one of the following:

two or more initial sputum smear examinations positive for acid fast bacilli (AFB);•one sputum examination positive for AFB plus radiographic abnormalities consistent with active •pulmonary TB as determined by a clinician; orone sputum specimen positive for AFB and at least one sputum that is culture-positive for AFB.•

New smear-negative pulmonary tuberculosis: A case of pulmonary TB that does not meet the above definition for smear-positive TB.

Extrapulmonary tuberculosis: TB of organs other than the lungs, e.g., pleura, lymph nodes, abdomen, genito-urinary tract, skin, joints, bones, meninges. Diagnosis should be based on one culture-positive specimen, or histological or strong clinical evidence consistent with active extrapulmonary TB, followed by a decision by a clinician to treat with a full course of anti-TB chemotherapy. (A patient diagnosed with both pulmonary and extrapulmonary TB should be classified as a case of pulmonary TB.)

Re-treatment case: Patient previously treated for TB, undergoing treatment for a new episode of bacteriologically positive (sputum smear or culture) TB.

Relapse: A patient previously treated for TB and declared cured or treatment completed, who is later diagnosed with bacteriologically positive (culture smear) TB.

2. Definitions of treatment outcome

CuredFormer smear-positive patient who was smear-negative in the last month of treatment, and on at least one previous occasion .

Completed treatmentA patient who has completed treatment but who does not meet the criteria to be classified either as a cure or a failure .

Treatment success The sum of patients who are cured and those who have completed treatment .

Died A patient who dies for any reason during the course of treatment .

Failure Smear-positive patient who remained smear-positive at five months or later during treatment .

Defaulted A patient who has interrupted treatment for two consecutive months or more .

Transferred outA patient who has been transferred to another recording and reporting unit and for whom the treatment outcome is not known .

Not evaluatedA patient who did not have the treatment outcome evaluated .Note: In countries where culture is current practice, patients can be classified as cured or failed based on the culture results .

26 The case definition of new smear-positive changed in 2007 and will be applied in future regional reports .


8 | ANNEXES

3. Indicators to assess treatment outcome

Cure rate: Proportion of cured cases out of all cases registered in a given period (2006, in this report).

Treatment success rate: The sum of the proportion of patients who were cured and patients who completed treatment out of all cases registered in a given period. The global target is an 85% cure rate and a greater treatment success rate.

The cure rate and treatment success rate are expressed as a percentage of registered cases. The number of new cases registered for treatment in 2005 (reported in 2007) is compared to the number of cases notified as smear-positive in 2005 (reported in 2006). Differences may arise because NTPs do not compile data at the end of each calendar year, diagnoses may be incorrect, patients are lost between diagnosis and the start of treatment, or records may be lost. All registered cases should be evaluated. Data on the six standard, mutually exclusive outcomes of treatment are compiled. These figures are reported as percentages of all registered cases, so that the possible outcomes plus the fraction of cases not evaluated add up to 100%. When a country or area states the number of patients registered for treatment, but gives no outcomes, no result is reported, rather than reporting zero treatment success. Although treatment outcomes are expressed as percentages, they are referred to as rates. The six possible outcomes plus the fraction of cases not evaluated add up to 100%. If the number of registered cases is lower than the sum of the six outcomes or is missing, the denominator for treatment success will be the number evaluated or the number of smear-positive cases notified in the previous year, whichever is greater.

4. Case detection rate and DOTS detection rate

Directly observed treatment, short-course (DOTS)

The recommended strategy for TB control is comprised of:political commitment with increased and sustained financing; •case detection through quality-assured bacteriology;•standardized treatment with supervision and patient support;•an effective drug supply and management system; and•monitoring and evaluation system, and impact measurement.•

Targets for TB control established by the World Health Assembly (1991)To cure 85% of the sputum smear-positive TB cases detected.•To detect 70% of the estimated new sputum smear-positive TB cases.•

Case notifications represent only a fraction of the true number of cases in a country or area because the coverage by effective NTP may be incomplete.

The estimated cases detection rate is defined as:

Case detection rate (%) = Annual new smear-positive notifications (country and area)

Estimated annual new smear-positive incidence (country and area)

DOTS detection rate (%) = Annual new smear-positive notifications under DOTS

Estimated annual new smear-positive incidence (country and area

DOTS detection rate

Case detection under DOTS:Note: The case detection rate and DOTS detection rate are identical when a country or area has a 100% DOTS enrolment rate . Updated estimated incidence for 2006 used in this report was provided by World Health Organization (WHO) .

Population with access to DOTS: The country and area’s population who live in administrative areas where DOTS services are available .

DOTS enrolment rate (%): This rate indicates a proportion of cases enrolled in DOTS, out of notified cases .

DOTS enrolment rate (all forms) (%) = Annual notifications of all forms under DOTS

Total annual notifications of all forms

DOTS enrolment rate (new ss+) (%) = Annual notification of new ss+ under DOTS

Total annual notifications of new ss+


8 | ANNEXES

5. Definitions of MDR-TB and XDR-TB

MDR-TB, or multidrug-resistant TBStrains of TB that are resistant to at least the two main first-line anti-TB drugs—isoniazid and rifampicin .

XDR-TB, or extensively drug-resistant TBTB that is resistant to any fluoroquinolone, and at least one of three injectable second-line drugs (capreomycin, kanamycin, and amikacin), in addition to MDR-TB . The WHO Global Task Force on XDR-TB agreed on this definition of XDR-TB in October 2006 .


8 | ANNEXES

Annex 4: Formulas for estimating tuberculosis incidence, prevalence, and mortality

Formulas Definitions

1 . I = dT

and dsTsIs

N = PopulationI = Incidence of tuberculosis (TB) = number of new cases of TB per year

2. P = tl and Ps= sslt P = Prevalence of TB

3. NIs

= λk T = TB case notifications (per year)D = Deaths from TB

4. D = fl and Ds= fls

IRR = TB incidence rate ratio (TB incidence rate in HIV-positive persons/TB incidence in HIV-negative persons)

5. I = Ia++Ia

-+In or I = ma

+ra+Na

++ma-ra

-Na-+mnrnNn

d = Proportion of cases notified (case detection rate)t = Average duration of TB disease (years)λ = Rate of infection with Mycobacterium tuberculosis (MTB) (annual rate of infection per person per year)k = Ratio of incidence of smear-positive TB to rate of MTB infection

6 . t = Proportion of TB patients who die from TB (case fatality rate [CFR])m = Prevalence of infection with MTB

7. r = Rate of progression to TB disease in MTB-infected individuals (per person per year)s = Sputum smear-positive TB (no subscript implies all forms)a = Adult (15–49 years old)

8. n = Other age groups (<15 or >49), assumed HIV-uninfected

9. Da* = Da

+-f - (I+-Ia*)

+ = HIV-positive- = HIV-negative* = Attributable to HIV infection

10 . h = Prevalence of HIV in new TB casesp = Prevalence of HIV in the general population

Adapted from: Corbett EL et al . The Growing Burden of Tuberculosis . Global Trends and Interactions with the HIV Epidemic . Archives of Internal Medicine, 2003, 163(9):1009–21 .

aa

aa

aa

aa

NINI

rmrmIRR

//

)1(1

IRRNN

NNIRR

II

a

a

a

a

a

a

a

aaaa N

NIII *

11

IRRpIRRph


8 | ANNEXES

Annex 5: Explanatory notes for tables

Regional summary and country and area data are presented in the following 12 tables. All rates are per 100 000 population.

Table 35: Estimated burden of TB, 2000 and 2006Estimates of incidence, prevalence and mortality for 2000 (baseline year for impact goals endorsed by the Regional Committee) and 2006 (the latest year covered by this report). See Annexes 4 for details of calculations. All estimates include TB in people living with HIV.

Table 36: Whole country and area case notifications and case detection rates, 2006Case notifications by history (new or re-treatment), by site (pulmonary or extrapulmonary) and by smear status (smear-positive, smear-negative, or unknown). Proportions of case types and estimated case detection rate for whole country and area (DOTS and non-DOTS combined).

Population, source:• World Population Prospects: The 2006 Revision. New York: United Nations Population Division, 2007.Country/Area total:• the total number of TB cases according to the country and area’s own reporting convention (in many countries this matches the World Health Organization (WHO) total – new and relapse; other countries and areas include re-treatment cases and/or cases with unknown treatment history).WHO total:• new and relapse cases.New pulmonary ss+:• new pulmonary cases in which diagnosis has been confirmed by smear examination.New pulmonary ss-/unk.:• new pulmonary cases in which diagnosis has not been confirmed by smear examination or the result is unknown.New extrapulmonary:• new extrapulmonary cases. Other new:• new cases for which the site of disease is not recorded.Other re-treat.:• re-treatment cases for which the outcome of previous treatment is unknown.Other:• cases for which neither treatment history nor site of disease is recorded.New pulm. lab. confirm.:• new pulmonary cases in which diagnosis has been confirmed by smear and/or culture examination.Case detection rate, all new:• notified (all new) cases divided by estimated incident cases (expressed as a percentage).Case detection rate, new ss+:• notified new smear-positive cases divided by estimated incident smear-positive cases (expressed as a percentage).ss+ (% of pulm.):• the percentage of all new pulmonary cases that are smear-positive.ss+ (% of new+relapse):• the percentage of new and relapse cases that are smear-positive.Extrapulm. (% of new+relapse):• the percentage of all new and relapse cases that are extrapulmonary.Re-treat. (% of new+re-treat.):• notified re-treatment cases as a percentage of all notified cases.

Table 37: DOTS coverage, case notifications, and case detection rates, 2006DOTS coverage: the percentage of the national population living in areas where health services have adopted DOTS.


8 | ANNEXES

Table 38:

Laboratory services, management of MDR-TB, and collaborative TB-HIV activitiesLaboratory services

Number of laboratories:• the number of laboratories working with the national TB control programme (NTP) that perform smear microscopy, culture or anti-TB drug susceptibility testing (DST), and the number of laboratories performing smear microscopy that are included in external quality assessment (EQA).

MDR-TB, 2006

Lab-confirmed MDR among new & re-treat. cases:• number of laboratory-confirmed cases of multidrug-resistant (MDR)-TB identified among TB patients (new and re-treatment) diagnosed in 2006.

DST in new cases:• number of new TB cases in 2005 for which DST was performed at start of treatment.

MDR in new cases:• number of new cases identified as MDR-TB based on DST at start of treatment.

Re-treat. with DST:• number re-treatment cases registered in 2006 for which DST was performed at start of treatment.

Re-treat. MDR:• number of re-treatment cases identified as MDR-TB based on DST at start of treatment.

Collaborative TB-HIV activities, 2005 and 2006

TB patients tested for HIV:• the number of TB patients tested for HIV.

Of those tested, HIV positive:• the number of TB patients found to be HIV-positive.

Of those HIV positive, started co-trimoxazole (CTX):• the number of HIV-positive TB patients given CPT.

Of those HIV positive, started antiretroviral therapy (ART):• the number of HIV-positive TB patients given ART during their TB treatment.

Table 39: Treatment outcomes, 2005 cohortTreatment outcomes of new smear-positive cases treated under DOTS, non-DOTS and re-treatment cases under DOTS.

Table 40: Re-treatment outcome, 2005 cohortRe-treatment outcomes of smear-positive cases treated under DOTS after relapse, treatment failure or default.

Table 41: DOTS treatment success and case detection rates, 1994–2006Treatment success rates (the proportion of registered cases cured or completed treatment) for new smear-positive cases treated under DOTS from 1994 to 2005 and smear-positive case detection rates under DOTS from 1995 to 2006.

Table 42: New smear-positive case notification by age and sex, absolute numbers, DOTS and non-DOTS, 2006Breakdown by age and sex of new smear-positive cases notified from whole country and area (DOTS and non-DOTS). Some countries and areas cannot provide the breakdown for all smear-positive notified cases.


8 | ANNEXES

Table 43:

New smear-positive case notification rates by age and sex, DOTS and non-DOTS, 2006Notification rates of new smear-positive cases by age and sex (DOTS + non-DOTS). Rates are missing where breakdown of smear-positive notified cases is not provided, or when age- and sex-specific population data are not available. In the regional summary row, rates exclude those countries for which breakdown of notified cases or population by age and sex is missing.

Table 44: Number of TB cases notified, 1980–2006

Table 45: Case notification rates, 1980–2006

Table 46: New smear-positive cases notified, numbers and rates, 1993–2006


8 | ANNEXES

Incidence, 2000 Prevalence, 2000 TB Mortality, 2000 Incidence, 2006

All forms* Smear-positive* All forms* All forms* All forms* All forms HIV+

number rate number rate number rate number rate number rate number rate

American Samoa 6 10 3 4 8 15 1 2 6 9 – –

Australia 1183 6 531 3 1203 6 118 1 1 329 6 33 0

Brunei Darussalam 187 56 84 25 188 56 14 4 317 83 28 7

Cambodia 67 531 530 30 022 236 102 696 806 12 981 102 70 949 500 6841 48

China 1 342 844 105 604 056 47 3 457 531 271 251 339 20 1 311 184 99 4135 0

Cook Islands 3 18 1 8 5 26 1 3 2 16 – –

Fiji 228 28 102 13 311 38 37 5 184 22 1 0

French Polynesia 92 39 41 17 121 51 14 6 68 26 – –

Guam 65 42 29 19 90 58 7 5 64 37 – –

Hong Kong (China) 5624 85 2529 38 5743 87 484 7 4 433 62 – –

Japan 43 429 34 19 531 15 57 039 45 5257 4 28 330 22 118 0

Kiribati 376 420 169 189 501 559 57 64 348 372 – –

Lao People’s Democratic Republic 8552 162 3848 73 18 272 346 1459 28 8 779 152 161 3

Macao (China) 376 85 169 38 385 87 33 7 283 59 – –

Malaysia 24 821 108 11 144 48 31 979 139 3860 17 26 877 103 2964 11

Marshall Islands 129 248 58 111 224 430 24 47 127 220 – –

Micronesia 137 128 61 57 183 171 21 19 112 101 – –

Mongolia 4987 200 2244 90 7125 285 903 36 4 893 188 7 0

Nauru 15 119 7 54 25 206 3 21 11 106 – –

New Caledonia 85 39 38 18 103 48 12 5 63 27 – –

New Zealand 406 11 183 5 416 11 41 1 352 9 4 0

Niue 1 48 0 22 2 96 0 10 1 43 – –

Northern Mariana Islands 59 84 26 38 59 84 4 6 61 75 – –

Palau 11 58 5 26 22 115 2 8 10 51 – –

Papua New Guinea 13 221 250 5906 111 33 758 637 3131 59 15 473 250 618 10

Philippines 231 295 305 104 074 137 419 962 554 44 195 58 247 740 287 151 0

Republic of Korea 42 177 90 18 965 41 66 370 142 5430 12 42 359 88 314 1

Samoa 41 23 19 11 47 27 5 3 36 19 – –

Singapore 1505 37 674 17 1553 39 170 4 1 128 26 31 1

Solomon Islands 756 181 340 81 1210 289 136 32 655 135 – –

Tokelau 1 56 0 25 2 112 0 12 1 56 – –

Tonga 28 28 12 12 34 34 3 3 24 25 – –

Tuvalu 37 362 17 163 74 723 7 73 31 295 – –

Vanuatu 133 70 60 31 167 87 13 7 128 58 – –

Viet Nam 144 460 184 64 866 82 197 838 251 18 821 24 148 918 173 7416 9

Wallis and Futuna 8 52 3 23 15 103 2 11 7 46 – –

Western Pacific Region 1 934 810 115 869 821 52 4 405 261 261 348 585 21 1 915 285 109 22 823 1

* Incidence, prevalence and mortality estimates include patients with HIV. Estimates labelled “HIV+” are estimates of TB in HIV-positive adults (age 15-49). Estimates for all years are re-calculated as new information becomes available and techniques are refined, so they may differ from those published previously. See Explanatory notes on page 67 for further details. Data can be downloaded from http://stoptb.wpro.who.int.

Annex 6: Tables

TABLE 35: Estimated burden of TB, 2000 and 2006


8 | ANNEXES

Incidence, 2006 Prevalence, 2006 TB mortality, 2006

HIV prevalencein adult incident

TB cases (%)

Smear-positive* Smear-positive HIV+ All forms* All forms HIV+ All forms* All forms HIV+

number rate number rate number rate number rate number rate number rate

3 4 – – 8 12 – – 1 1 – – – American Samoa

595 3 12 0 1341 7 17 133 1 3 0 2 .5 Australia

140 37 10 3 377 99 14 4 43 11 7 2 8 .9 Brunei Darussalam

31 243 220 2394 17 94 433 665 3420 24 13 054 92 2279 16 9 .6 Cambodia

589 619 45 1447 0 2 658 377 201 2068 200 820 15 1170 0 0 .3 China

1 7 – – 3 24 – – 3 – – – Cook Islands

83 10 0 0 254 30 25 3 0 0 .3 Fiji

31 12 – – 75 29 – – 9 3 – – – French Polynesia

29 17 – – 83 49 – – 10 6 – – – Guam

1995 28 – – 4533 64 – – 381 5 – – – Hong Kong (China)

12 736 10 41 0 37 490 29 59 3486 3 13 0 0 .4 Japan

157 168 – – 376 402 – – 42 45 – – – Kiribati

3934 68 57 1 16 846 292 81 1 1368 24 54 1 1 .8 Lao People’s Democratic Republic

127 27 – – 283 59 – – 21 4 – – – Macao (China)

11 798 45 1037 4 32 554 125 1482 6 4515 17 857 3 11 Malaysia

57 99 – – 140 241 – – 16 28 – – – Marshall Islands

50 45 – – 121 109 – – 14 12 – – – Micronesia

2201 85 2 0 4962 191 4 398 15 1 0 0 .1 Mongolia

5 48 – – 14 134 – – 2 15 – – – Nauru

28 12 – – 83 35 – – 9 4 – – – New Caledonia

158 4 2 0 358 9 2 35 1 0 1 .3 New Zealand

0 19 – – 1 85 – – 9 – – – Niue

28 34 – – 74 90 – – 8 10 – – – Northern Mariana Islands

5 23 – – 10 51 – – 1 4 – – – Palau

6901 111 216 3 31 830 513 309 5 3006 48 164 3 4 .0 Papua New Guinea

111 468 129 53 0 372 841 432 75 38 995 45 49 0 0 .1 Philippines

19 030 40 110 0 59 219 123 157 4790 10 34 0 0 .7 Republic of Korea

16 9 – – 47 25 – – 5 3 – – – Samoa

505 12 11 0 1113 25 15 98 2 3 0 2 .7 Singapore

295 61 – – 939 194 – – 111 23 – – – Solomon Islands

0 25 – – 2 112 – – 12 – – – Tokelau

11 11 – – 34 34 – – 3 3 – – – Tonga

14 133 – – 53 504 – – 6 55 – – – Tuvalu

58 26 – – 144 65 – – 17 8 – – – Vanuatu

66 271 77 2596 3 193 946 225 3708 4 19 819 23 1910 2 5 .0 Viet Nam

3 21 – – 9 60 – – 1 7 – – – Wallis and Futuna

859 596 49 7988 0 3 512 972 199 11 412 1 291 240 17 6545 0 1.2 Western Pacific Region


8 | ANNEXES

TABLE 36: Whole country and area case notifications and case detection rates, 2006

Populationthousands

TB cases notified from whole country and area (DOTS + non-DOTS)

Country/Areatotal

number

New and relapse(WHO total)

New pulmonary

New extra-pulmonary

number

Other new

number

Re-treatment cases

ss+ss-/unk.number

Relapsenumber

After failurenumbernumber rate number rate

American Samoa 65 4 4 6 3 5 1

Australia 20 530 1203 1159 6 269 1 405 451 2 32

Brunei Darussalam 382 202 202 53 128 34 15 35 12 12

Cambodia 14 197 35 466 34 660 244 19 294 136 6875 7800 691 71

China 1 320 864 1 011 388 940 889 71 468 291 35 382 492 38 294 4286 47 526 3003

Cook Islands 14 1 1 7 0 1

Fiji 833 114 114 14 73 9 22 18 1

French Polynesia 259 69 69 27 24 9 28 15 2

Guam 171 44 44 26 21 12 15 8

Hong Kong (China) 7132 5773 5356 75 1547 22 2900 699 210

Japan 127 953 26 384 25 304 20 10 159 8 9098 5203 844

Kiribati 94 379 378 404 129 138 121 124 4

Lao People’s Democratic Republic 5759 3994 3958 69 3041 53 457 325 135 18

Macao (China) 478 437 374 78 144 30 174 45 11

Malaysia 26 114 16 665 16 051 61 9414 36 4336 1920 381 23

Marshall Islands 58 148 138 238 45 78 43 41 9

Micronesia 111 113 104 94 41 37 37 23 3 3

Mongolia 2605 5216 5049 194 2129 82 724 1922 274 91

Nauru 10 12 12 118 2 20 4 4 2

New Caledonia 238 50 48 20 9 4 22 10 7

New Zealand 4140 355 344 8 97 2 103 105 30 9

Niue 2 0 0

Northern Mariana Islands 82 51 51 62 15 18 32 4

Palau 20 12 12 59 6 30 2 4

Papua New Guinea 6202 13 532 12 620 203 1948 31 5969 4575 128

Philippines 86 264 148 217 147 305 171 85 740 99 55 964 1445 4156 74

Republic of Korea 48 050 46 284 37 861 79 11 513 24 18 804 5044 2500 147

Samoa 185 26 25 13 13 7 8 2 2 1

Singapore 4382 1420 1314 30 538 12 525 183 68 4

Solomon Islands 484 371 371 77 124 26 168 74 5

Tokelau 1 0 0

Tonga 100 18 18 18 14 14 3 1

Tuvalu 10 9 9 86 4 38 3 2

Vanuatu 221 132 126 57 42 19 37 47 1

Viet Nam 86 206 98 284 97 363 113 56 437 65 16 645 17 711 6570 558

Wallis and Futuna 15

Western Pacific Region 1 764 231 1 416 373 1 331 333 75 671 254 38 506 031 86 136 4332 63 580 3994

ss+ = sputum smear-positive; ss- = sputum smear-negative; unk. = sputum smear result unknown; re-treat. = re-treatment; pulm. lab. confirm. = pulmonary case confirmed by positive smear or culture. See Explanatory notes on page 67 for further details. Data can be downloaded from http://stoptb.wpro.who.int.


8 | ANNEXES

Incidence and case detection rates Proportions

Re-treatment cases

Othernumber

New pulm.lab. con-

firm.

Estimated incidence Case detection rate

ss+(% of

pulm.)

ss+(% of new+

relapse)

Extrapulm.(% of new+

relapse)

Re-treat.(% of

new+ re-treat.)

After defaultnumber

Other re-treat.number

all formsnumber

ss+number

all new %

new ss+%

3 6 3 69 115 100 75 25 American Samoa

4 36 4 602 1329 595 85 45 40 23 39 6 Australia

144 317 140 60 91 90 63 17 6 Brunei Darussalam

26 709 19 294 70 949 31 243 48 62 74 56 23 4 Cambodia

3800 23 689 40 007 468 291 1 311 184 589 619 68 79 55 50 4 8 China

2 1 47 0 100 Cook Islands

73 184 83 61 88 77 64 16 1 Fiji

51 68 31 98 78 46 35 22 3 French Polynesia

21 64 29 69 73 58 48 18 Guam

13 404 3236 4433 1995 116 78 35 29 13 11 Hong Kong (China)

1080 10 159 28 330 12 736 86 80 53 40 21 7 Japan

1 129 348 157 107 82 52 34 33 1 Kiribati

18 3183 8779 3934 44 77 87 77 8 4 Lao People’s Democratic Republic

4 20 39 281 283 127 128 113 45 39 12 9 Macao (China)

164 427 15 311 26 877 11 798 58 80 68 59 12 6 Malaysia

9 1 45 127 57 101 79 51 33 30 12 Marshall Islands

6 54 112 50 90 82 53 39 22 11 Micronesia

35 41 2129 4893 2201 98 97 75 42 38 8 Mongolia

2 11 5 112 42 33 17 33 Nauru

2 27 63 28 65 32 29 19 21 15 New Caledonia

11 156 352 158 95 61 49 28 31 6 New Zealand

1 0 0 Niue

18 61 28 83 54 32 29 8 Northern Mariana Islands

6 10 5 116 129 75 50 33 Palau

912 2076 15 473 6901 81 28 25 15 36 8 Papua New Guinea

52 786 86 308 247 740 111 468 58 77 61 58 1 3 Philippines

356 3699 4221 16 584 42 359 19 030 83 60 38 30 13 16 Republic of Korea

13 36 16 64 80 62 52 8 12 Samoa

9 83 10 889 1128 505 110 107 51 41 14 12 Singapore

124 655 295 56 42 42 33 20 1 Solomon Islands

1 0 0 Tokelau

15 24 11 74 127 82 78 6 Tonga

4 31 14 29 29 57 44 22 Tuvalu

1 4 42 128 58 98 73 53 33 37 2 Vanuatu

363 56 437 148 918 66 271 61 85 77 58 18 8 Viet Nam

7 3 Wallis and Futuna

4845 31 913 44 288 685 707 1 915 285 859 596 66 78 57 50 6 8 Western Pacific Region


8 | ANNEXES

DOTScoverage

%

TB cases reported from DOTS services

New and relapse(WHO total)

New pulmonary

New extra-pulmonary

number

Othernew

number

Re-treatment cases.

ss+ss-/unk.number

Relapsenumber

After failurenumber

After defaultnumbernumber rate number rate

American Samoa 100 4 6 3 5 1

Australia 97 1053 5 238 1 361 423 1 30 4

Brunei Darussalam 100 202 53 128 34 15 35 12 12

Cambodia 100 34 660 244 19 294 136 6875 7800 691 71 26

China 100 940 889 71 468 291 35 382 492 38 294 4286 47 526 3003 3800

Cook Islands 80 1 7 0 1

Fiji 100 114 14 73 9 22 18 1

French Polynesia 100 69 27 24 9 28 15 2

Guam 100 44 26 21 12 15 8

Hong Kong (China) 100 3785 53 1116 16 2045 482 142 12

Japan 99 25 060 20 10 068 8 9012 5143 837

Kiribati 100 378 404 129 138 121 124 4


Macao (China) 100 374 78 144 30 174 45 11 4

Malaysia 100 16 051 61 9414 36 4336 1920 381 23 164

Marshall Islands 100 138 238 45 78 43 41 9

Micronesia 98 104 94 41 37 37 23 3 3

Mongolia 100 5049 194 2129 82 724 1922 274 91 35

Nauru 100 12 118 2 20 4 4 2

New Caledonia 100 48 20 9 4 22 10 7

New Zealand 100 344 8 97 2 103 105 30 9

Niue 100 0 0

Northern Mariana Islands 100 51 62 15 18 32 4

Palau 100 12 59 6 30 2 4

Papua New Guinea 40 8165 132 1481 24 3241 3315 128

Philippines 100 147 305 171 85 740 99 55 964 1445 4156 74 52

Republic of Korea 100 9982 21 3431 7 5442 145 964 95

Samoa 100 25 13 13 7 8 2 2 1

Singapore 100 1314 30 538 12 525 183 68 4 9

Solomon Islands 100 371 77 124 26 168 74 5

Tokelau 0

Tonga 100 18 18 14 14 3 1

Tuvalu 100 9 86 4 38 3 2

Vanuatu 100 126 57 42 19 37 47 1 1

Viet Nam 100 97 363 113 56 437 65 16 645 17 711 6570 558 363

Wallis and Futuna

Western Pacific Region 100 1 297 078 74 662 152 38 488 956 79 672 4331 61 967 3847 4583

ss+ = sputum smear-positive; ss- = sputum smear-negative; unk. = sputum smear result unknown; re-treat. = re-treatment; pulm. lab. Confirmed = pulmonary case confirmed by positive smear or culture. See Explanatory notes on page 67 for further details. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 37: DOTS coverage, case notifications and case detection rates, 2006


8 | ANNEXES

Estimated incidence and case detection rate Proportions

Other re-treat.

numberOther

number

New pulm.lab. confirm.

number

Estimated incidence Case detection rate

ss+(% of

pulm.)

ss+(% of new+

relapse)

Extrapulm.(% of

new+ relapse)

Re-treat.(% of

new+re-treat.)

all formsnumber

ss+number

all new%

new ss+%

3 6 3 69 115 100 75 25 American Samoa

36 4 527 1329 595 77 40 40 23 40 6 Australia


709 19 294 70 949 31 243 48 62 74 56 23 4 Cambodia

23 689 40 007 468 291 1 311 184 589 619 68 79 55 50 4 8 China

2 1 47 0 100 Cook Islands

73 184 83 61 88 77 64 16 1 Fiji


21 64 29 69 73 58 48 18 Guam

303 2207 4433 1995 82 56 35 29 13 11 Hong Kong (China)

1070 10 068 28 330 12 736 86 79 53 40 21 7 Japan

1 129 348 157 107 82 52 34 33 1 Kiribati

3183 8779 3934 44 77 87 77 8 4 Lao People’s Democratic Republic

20 281 283 127 128 113 45 39 12 9 Macao (China)

427 15 311 26 877 11 798 58 80 68 59 12 6 Malaysia

9 1 45 127 57 101 79 51 33 30 12 Marshall Islands

6 54 112 50 90 82 53 39 22 11 Micronesia

41 2129 4893 2201 98 97 75 42 38 8 Mongolia

2 11 5 112 42 33 17 33 Nauru

2 27 63 28 65 32 29 19 21 15 New Caledonia

11 156 352 158 95 61 49 28 31 6 New Zealand

1 0 0 Niue

18 61 28 83 54 32 29 8 Northern Mariana Islands

6 10 5 116 129 75 50 33 Palau

1609 15 473 6901 52 21 31 18 41 2 Papua New Guinea

786 86 308 247 740 111 468 58 77 61 58 1 3 Philippines

950 969 4892 42 359 19 030 21 18 39 34 1 18 Republic of Korea

13 36 16 64 80 62 52 8 12 Samoa

83 10 889 1128 505 110 107 51 41 14 12 Singapore

124 655 295 56 42 42 33 20 1 Solomon Islands

1 Tokelau

15 24 11 74 127 82 78 6 Tonga

4 31 14 29 29 57 44 22 Tuvalu

4 42 128 58 98 73 53 33 37 2 Vanuatu

56 437 148 918 66 271 61 85 77 58 18 8 Viet Nam

7 3 Wallis and Futuna

28 141 40 997 672 353 1 915 285 859 596 64 77 58 51 6 7 Western Pacific Region


8 | ANNEXES

Laboratory services Multidrug-resistant TB, 2006

Number of laboratories

Laboratories included

in EQA

Lab-confirmedMDR among

new& re-treat.

cases number

DST in new cases

number

MDR innew cases

number

Re-treat. with DSTnumber

Re-treat.MDR

number smear culture DST

American Samoa

Australia 127 33 6 127 27 951 17 69 10

Brunei Darussalam 1 1 1

Cambodia 186 3 1 186

China 3010 360 90 2770 2 10 2

Cook Islands 1 1

Fiji 4 1 4 43 1

French Polynesia 4 2 2 40 2

Guam 3 2 2 3 1 34 1

Hong Kong (China) 1 1 1 1 35 3338 27 388 8

Japan

Kiribati 1

Lao People’s Democratic Republic 155 135

Macao (China) 8 1 1 1 7 251 7 27

Malaysia 241 1 1 42

Marshall Islands 2 38 3

Micronesia 5 4 2 21 2 2 2

Mongolia 36 1 1 36 98 48 9 250 89

Nauru 2 2

New Caledonia 3 3 1 1 1 41 1

New Zealand 10 10 3 10 1 250 1 16

Niue

Northern Mariana Islands 1 1 2 18 2

Palau 1 1

Papua New Guinea 60 1 1 15

Philippines 2374 3 3 2374 403 33 19 424 384

Republic of Korea 260 12 1

Samoa 1 1

Singapore 4 2 2 4 6 861 3 101 3

Solomon Islands 9 1 1 9 364 5

Tokelau

Tonga 1 1

Tuvalu 1 1

Vanuatu 6 3 6

Viet Nam 874 18 2 740

Wallis and Futuna

Western Pacific Region 7390 458 122 6433 629 6331 89 1298 498

ART = antiretroviral treatment; BMU = basic management unit; DST = drug susceptibility testing; EQA = external quality assessment; MDR = multidrug-resistant; re-treat. = re-treatment.

TABLE 38: Laboratory services, management of MDR-TB and collaborative TB-HIV activities


8 | ANNEXES

Collaborative TB-HIV activities

2005 2006

TB patients tested for

HIV

Of those tested,

HIV positive

Of those HIVpositive, started cotrimoxazole

Of those HIVpositive, started

ART

TB patients tested for

HIV

Of those tested,

HIV positive

Of those HIVpositive, started cotrimoxazole

Of those HIVpositive, started

ART

American Samoa

448 22 2 439 22 3 1 Australia

163 2 202 1 Brunei Darussalam

1044 86 3547 342 239 120 Cambodia

1350 18 26 60 China

Cook Islands

132 1 114 3 2 2 Fiji

30 26 French Polynesia

46 40 Guam

4209 35 17 19 4511 33 19 15 Hong Kong (China)

Japan

44 2 Kiribati

404 51 Lao People’s Democratic Republic

378 1 1 398 5 2 Macao (China)

11 661 1468 13 039 1438 Malaysia

86 103 Marshall Islands

7 55 Micronesia

1 1 1 1 1 1 1 1 Mongolia

Nauru

21 25 New Caledonia

140 8 129 10 New Zealand

Niue

56 50 Northern Mariana Islands

9 9 Palau

Papua New Guinea

Philippines

Republic of Korea

2 Samoa

Singapore

0 Solomon Islands

0 Tokelau

Tonga

0 Tuvalu

0 Vanuatu

14 128 595 14 230 708 Viet Nam

Wallis and Futuna

32 605 2221 20 21 38 672 2632 290 201 Western Pacific Region


8 | ANNEXES

New smear-positive cases, DOTS

Number of cases %

of notifregist’d

% of cohort

%Success

Number of cases

CuredCom -

pleted Died Failed DefaultTrans-ferred

Noteval.Notified Regist'd Notified Regist'd

American Samoa 3 4 133 75 25 0 75

Australia 219 219 100 12 68 9 2 9 0 80 22 22


Cambodia 21 001 21 001 100 89 4 3 0 2 2 0 93

China 472 719 472 719 100 92 2 2 1 1 1 2 94

Cook Islands 1 1 100 100 0 0 0 0 0 0 100

Fiji 63 68 108 71 0 10 0 10 1 7 71

French Polynesia 21 18 86 89 11 0 0 0 0 89

Guam 27 27 100 85 0 11 0 0 4 0 85

Hong Kong (China) 1266 1266 100 74 3 5 11 3 2 1 77 295 295

Japan 9297 10 819 116 38 22 11 3 1 26 60 1634 112

Kiribati 124 123 99 62 31 7 0 1 0 0 93


Macao (China) 136 136 100 93 0 4 0 1 1 1 93

Malaysia 8446 8446 100 69 1 9 0 5 6 10 70

Marshall Islands 48 47 98 85 2 2 2 9 0 87

Micronesia 32 20 63 75 5 10 5 0 5 0 80

Mongolia 1868 1868 100 82 6 3 5 3 2 0 88

Nauru 3 0 67 33 0 0 0 0 67

New Caledonia 16 16 100 88 6 6 0 0 0 0 94

New Zealand 83 84 101 0 60 6 0 1 6 27 60

Niue


Palau 3 3 100 100 0 0 0 0 0 0 100

Papua New Guinea 1346 1292 96 57 14 4 1 19 5 0 71 459

Philippines 81 647 81 125 99 82 7 2 1 4 2 0 89

Republic of Korea 3758 3752 100 81 2 1 1 4 11 0 83 7880

Samoa 11 11 100 91 0 9 0 0 0 0 91

Singapore 552 548 99 83 14 0 2 1 1 83

Solomon Islands 169 169 100 56 30 8 0 4 2 0 85

Tokelau

Tonga 11 11 100 73 0 18 0 0 9 0 73

Tuvalu 5 6 120 100 0 0 0 0 0 0 100

Vanuatu 35 42 120 64 17 10 7 2 0 0 81

Viet Nam 55 492 55 492 100 90 2 3 1 1 2 0 92

Wallis and Futuna 1

Western Pacific Region 661 322 662 254 100 89 3 2 1 1 1 2 92 10 290 429

Not eval. = not evaluated (percentage of registered cases for which outcomes were not recorded); success = sum of cured and completed; cases regist’d, = the denominator for calculating treatment outcomes. The number of cases registered for treatment in 2005 is used as the denominator for calculating treatment outcomes unless it is less than the sum of outcomes, in which case the sum of outcomes is used. If the number of cases registered is not reported, then the number of cases notified in 2005 is used, or the sum of outcomes if the latter is greater. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 39: Treatment outcomes, 2005 cohort


8 | ANNEXES

New smear-positive cases, non-DOTS Smear-positive re-treatment cases, DOTS

% of notifregist’d

% of cohort

. %Suc-cess

NumberRegist’d

% of cohort

%SuccessCured

Com -pleted Died Failed

De-fault

Trans-ferred

Noteval. Cured

Com -pleted- Died Failed Default

Trans-ferred

Noteval.

1 0 100 0 0 0 0 0 100 American Samoa

100 14 68 18 0 82 39 18 56 3 0 5 18 0 74 Australia


1306 49 27 9 2 3 4 7 76 Cambodia

89 239 85 5 3 3 1 1 3 90 China

0 Cook Islands

0 Fiji


2 50 0 0 0 50 0 0 50 Guam

100 3 1 3 1 0 0 93 3 568 50 23 5 11 8 2 2 73 Hong Kong (China)

7 24 21 4 5 2 44 46 1980 29 16 8 2 2 0 43 45 Japan

3 100 0 0 0 0 0 0 100 Kiribati

181 75 12 6 2 5 0 1 87 Lao People’s Democratic Republic

37 51 24 11 0 0 3 11 76 Macao (China)

1056 46 9 8 1 9 8 19 55 Malaysia

20 60 10 0 0 0 30 0 70 Marshall Islands

9 11 89 0 0 0 0 0 100 Micronesia

443 39 34 9 11 4 2 0 73 Mongolia

1 0 0 0 0 0 0 100 0 Nauru

7 86 0 14 0 0 0 0 86 New Caledonia

18 0 67 0 0 0 22 11 67 New Zealand

0 Niue

0 Northern Mariana Islands

0 Palau

65 42 14 15 6 20 3 0 55 Papua New Guinea

Philippines

3331 72 3 2 0 6 18 0 75 Republic of Korea

0 Samoa

149 0 79 15 0 5 0 1 79 Singapore

5 20 40 20 20 0 0 0 60 Solomon Islands

Tokelau

0 Tonga

0 Tuvalu

0 Vanuatu

7374 79 4 5 6 3 3 0 83 Viet Nam

Wallis and Futuna

4 9 10 4 2 0 0 75 18 105 843 81 6 3 3 2 2 4 87 Western Pacific Region


8 | ANNEXES

Relapse, DOTS After failure, DOTS

Numberregist’d

% of cohort

%Success

Numberregist’d

% of cohort

CuredCom-

pleted Died Failed DefaultTrans-ferred

Noteval. Cured

Com-pleted Died Failed

American Samoa

Australia 16 13 63 25 0 75 2 50

Brunei Darussalam 5 40 40 20 0 0 0 0 80 0 0 0 0

Cambodia 718 75 6 9 1 3 4 2 81 62 34 5 6 23

China 49 707 85 5 3 3 1 1 3 89

Cook Islands 0 0 0 0 0 0 0 0 0 0 0 0 0

Fiji 0 0 0 0 0 0 0 0 0 0 0 0 0

French Polynesia 4 75 25 75

Guam 1 100 0 0 0 0 0 0 100 0 0 0 0

Hong Kong (China) 177 69 7 4 10 4 3 2 76 0 0 0 0

Japan 862 41 22 10 3 2 23 62

Kiribati 3 100 0 100

Lao People’s Democratic Republic 148 78 10 6 1 4 0 1 88

Macao (China) 14 79 7 0 0 0 14 79 15 47 33 7 7

Malaysia 332 50 11 7 0 6 8 18 60 29 41 3 0

Marshall Islands 13 85 15 0 100

Micronesia 1 100 0 100

Mongolia 216 53 21 11 9 5 2 0 74 94 30 35 10 20

Nauru 1 0 0 0 0 0 0 100 0 0 0 0 0

New Caledonia 1 100 0 0 0 0 0 0 100 0 0 0 0

New Zealand 10 0 60 0 0 0 30 10 60 0 0 0 0

Niue 0 0 0 0 0 0 0 0 0 0 0


Palau 0 0 0 0 0 0 0 0 0 0 0

Papua New Guinea 65 42 14 15 6 20 3 0 55

Philippines

Republic of Korea 1074 65 3 2 1 6 24 0 68 5 20 20 0

Samoa 0 0 0 0 0 0 0 0 0 0 0

Singapore 60 80 18 0 0 0 2 80

Solomon Islands 5 20 40 20 20 0 0 0 60 0 0 0 0

Tokelau

Tonga 0 0 0 0 0 0 0 0 0 0 0

Tuvalu 0 0 0 0 0 0 0 0 0 0 0

Vanuatu 0 0 0 0 0 0 0 0 0 0 0

Viet Nam 6325 81 4 5 5 2 3 0 85 577 64 3 5 19

Wallis and Futuna

Western Pacific Region 59 750 83 5 3 3 1 2 3 88 784 56 8 6 18

Not eval. = not evaluated (percentage of registered cases for which outcomes were not recorded); success = sum of cured and completed; cases regist’d = the denominator for calculating treatment outcomes. The number of cases registered for treatment in 2005 is used as the denominator for calculating treatment outcomes unless it is missing or is less than the sum of outcomes, in which case the sum of outcomes is used. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 40: Re-treatment outcomes, 2005 cohort


8 | ANNEXES

After failure, DOTS After default, DOTS

% of cohort

%Success

Numberregist’d

% of cohort

%SuccessDefault

Trans-ferred

Noteval. Cured

Com-pleted Died Failed Default

Trans-ferred

Noteval.

American Samoa

50 0 50 Australia

0 0 0 0 0 0 0 0 0 0 Brunei Darussalam

3 2 27 39 46 39 24 9 4 13 7 4 63 Cambodia

China

0 0 0 0 0 0 0 0 0 0 Cook Islands

0 0 0 0 0 0 0 0 0 0 Fiji

French Polynesia

0 0 0 0 0 0 0 0 0 0 Guam

24 33 4 4 17 38 0 4 38 Hong Kong (China)

Japan

Kiribati

26 77 12 0 0 0 12 88 Lao People’s Democratic Republic

7 0 0 80 5 20 40 20 0 0 0 20 60 Macao (China)

0 0 55 45 239 44 7 10 1 12 10 15 51 Malaysia

Marshall Islands

1 100 0 100 Micronesia

1 2 2 65 31 39 23 6 13 10 10 0 61 Mongolia

0 0 0 0 0 0 0 0 0 0 Nauru

0 0 0 0 0 0 0 0 0 0 New Caledonia

0 0 0 0 0 0 0 0 0 0 New Zealand

0 0 0 0 0 0 0 0 0 0 Niue

0 0 0 0 0 0 0 0 0 0 Northern Mariana Islands

0 0 0 0 0 0 0 0 0 Palau

Papua New Guinea

Philippines

0 60 40 125 49 2 2 2 20 25 0 51 Republic of Korea

0 0 0 0 0 0 0 0 0 0 Samoa

8 63 13 0 0 25 63 Singapore

0 0 0 0 0 0 0 0 0 0 Solomon Islands

Tokelau

0 0 0 0 0 0 0 0 0 0 Tonga

0 0 0 0 0 0 0 0 0 0 Tuvalu

0 0 0 0 0 0 0 0 0 0 Vanuatu

5 4 0 68 399 67 5 7 5 11 5 0 72 Viet Nam

Wallis and Futuna

4 4 4 64 904 55 8 7 4 13 9 5 62 Western Pacific Region


8 | ANNEXES

DOTS new smear-positive treatment success (%)

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

American Samoa 100 50 100 100 100 100 100 67 75

Australia 66 75 84 74 66 78 82 85 80

Brunei Darussalam 85 76 63 56 84 60 71 71

Cambodia 84 91 94 91 95 93 91 92 92 93 91 93

China 94 96 96 96 97 96 95 96 93 94 94 94

Cook Islands 100 100 100 100 67 100 100

Fiji 90 86 86 91 90 92 85 85 78 86 71


Guam 94 93 71 68 96 100 85

Hong Kong (China) 85 78 76 78 79 78 80 77

Japan 76 70 75 76 76 57 60

Kiribati 83 88 91 86 94 88 94 93


Macao (China) 75 81 78 89 86 89 88 89 93

Malaysia 69 90 78 79 76 72 56 70

Marshall Islands 83 82 91 86 100 90 90 87

Micronesia 64 80 95 93 100 91 92 80 50

Mongolia 78 86 84 86 87 87 87 87 88 88

Nauru 50 25 100 50 67

New Caledonia 62 75 70 77 89 84 85 75 94 94

New Zealand 30 9 60 36 68 60

Niue 100

Northern Mariana Islands 80 81 74 71 75 88 73

Palau 64 67 75 100 38 80 100 100

Papua New Guinea 93 72 66 63 67 53 58 65 71

Philippines 80 82 83 84 87 88 88 88 88 87 89

Republic of Korea 71 76 71 82 83 82 80 83

Samoa 50 80 100 86 94 92 77 84 100 91

Singapore 88 86 95 85 88 87 77 81 83

Solomon Islands 65 73 92 92 81 89 90 87 87 85

Tokelau

Tonga 89 75 82 75 94 80 93 92 83 73

Tuvalu 100 100

Vanuatu 88 88 88 79 75 90 81

Viet Nam 91 91 90 85 93 92 92 93 92 92 93 92

Wallis and Futuna 100 100 100

Western Pacific Region 90 91 93 93 95 94 92 93 90 91 91 92

Treatment success = sum of cured and completed; DOTS new smear-positive case detection rate = notified (new and relapse) cases divided by estimated incident cases. The table includes updated information; data shown here may differ from those published in previous reports. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 41: DOTS treatment success and case detection rates, 1994–2006


8 | ANNEXES

DOTS new smear-positive case detection rate (%)

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

232 117 78 78 39 78 77 116 115 American Samoa

22 29 23 19 25 9 32 39 40 Australia

91 91 91 91 91 91 91 91 Brunei Darussalam

40 34 45 48 54 50 48 57 62 62 68 62 Cambodia

15 29 32 32 30 31 31 30 43 64 80 79 China

126 65 136 165 87 95 99 Cook Islands

57 60 59 68 62 61 74 78 85 70 74 88 Fiji

74 86 75 76 70 75 59 89 65 78 French Polynesia

147 161 106 76 94 73 Guam

64 67 61 65 66 64 61 56 Hong Kong (China)

23 32 37 46 51 67 79 Japan

7 33 37 34 40 52 63 90 79 82 Kiribati

24 33 40 45 40 41 47 48 57 72 77 Lao People’s Democratic Republic

88 136 164 150 95 98 90 99 101 107 113 Macao (China)

64 68 73 73 70 69 67 72 80 Malaysia

18 29 19 26 31 35 68 84 79 Marshall Islands

12 19 24 13 38 47 65 62 82 Micronesia

7 6 31 61 68 63 74 76 70 82 85 97 Mongolia

74 38 39 20 42 Nauru

43 55 49 50 50 75 43 60 60 32 New Caledonia

40 41 51 62 65 50 61 New Zealand

273 Niue

103 72 78 59 51 55 54 Northern Mariana Islands

184 81 141 183 103 104 64 129 Palau

1 7 8 7 8 15 16 17 20 21 Papua New Guinea

0 0 3 10 20 48 56 61 67 72 74 77 Philippines

30 60 56 62 26 23 20 18 Republic of Korea

73 44 71 89 70 60 107 69 65 66 80 Samoa

62 27 16 28 51 57 87 102 107 Singapore

25 31 40 27 32 36 33 44 49 56 42 Solomon Islands

Tokelau

67 106 85 126 80 123 67 196 95 70 98 127 Tonga

35 29 Tuvalu

40 44 81 53 68 101 60 73 Vanuatu

30 59 78 82 83 82 83 87 85 89 84 85 Viet Nam

29 30 213 32 Wallis and Futuna

16 28 32 33 32 37 39 39 50 65 77 77 Western Pacific Region


8 | ANNEXES

Male Female

0–14 15–24 25–34 35–44 45–54 55–64 65+ 0–14 15–24 25–34 35–44

American Samoa 1

Australia 1 33 35 23 21 16 43 2 18 27 14


Cambodia 50 791 1486 2205 1902 1689 1665 44 749 1330 1839

China 1023 44 528 48 232 56 733 54 301 53 746 68 557 1408 30 904 26 526 24 564

Cook Islands

Fiji 8 11 4 7 5 4 1 12 5 6

French Polynesia 1 1 1 3 3 1 1 1 6 1

Guam 1 1 2 3 2 6 1

Hong Kong (China) 3 73 86 136 175 161 443 9 59 98 74

Japan 3 175 436 529 743 1388 3728 5 179 361 280

Kiribati 3 18 18 16 18 3 7 5 15 5 5


Macao (China) 15 6 17 32 19 19 1 7 8 9

Malaysia 15 507 855 734 678 443 496 3 30 300 403

Marshall Islands 4 3 4 6 3 2 2 2 3 3

Micronesia 14 21 3 6 8 6 1 5 23 5 7

Mongolia 7 317 335 241 157 64 41 16 372 265 180

Nauru 1 1

New Caledonia 3 1 1 1 1

New Zealand 5 14 5 8 4 3 7 1 12 12 12

Niue

Northern Mariana Islands 2 3 1 2 2 3

Palau 1 1 2 1 1

Papua New Guinea 32 221 220 122 84 48 3 41 226 215 142

Philippines 419 7878 11 697 13 478 12 733 8074 4640 379 4337 5746 5630

Republic of Korea 19 652 1109 1223 1406 955 1698 27 579 859 507

Samoa 3 2 1 1 1 2 3

Singapore 2 7 31 67 107 75 106 19 22 22

Solomon Islands 1 13 11 4 4 14 8 4 16 14 9

Tokelau

Tonga 1 1 2 4 1 1 2

Tuvalu 1 1 1

Vanuatu 1 5 3 1 4 4 2 7 9 2

Viet Nam 49 3761 7549 8931 8717 5037 7408 62 1827 2381 2036

Wallis and Futuna

Western Pacific Region 1663 59 204 72 397 84 846 81 537 72 114 89 255 2032 39 521 38 404 35 981

TABLE 42: New smear-positive case notification by age and sex, absolute numbers, DOTS and non-DOTS, 2006


8 | ANNEXES

Female AllMale/female

ratio45–54 55–64 65+ 0–14 15–24 25–34 35–44 45–54 55–64 65+

2 1 2 American Samoa

7 9 21 3 51 62 37 28 25 64 1 .8 Australia

11 4 9 3 15 22 20 24 14 20 1 .4 Brunei Darussalam

2072 1915 1557 94 1540 2816 4044 3974 3604 3222 1 .0 Cambodia

18 775 17 782 21 212 2431 75 432 74 758 81 297 73 076 71 528 89 769 2 .3 China

Cook Islands

4 6 1 20 16 10 11 11 4 1 .1 Fiji

2 3 2 7 2 3 3 3 4 0 .8 French Polynesia

1 2 2 1 1 3 4 4 8 2 .5 Guam

55 41 134 12 132 184 210 230 202 577 2 .3 Hong Kong (China)

213 256 1863 8 354 797 809 956 1644 5591 2 .2 Japan

1 8 3 8 33 23 21 19 11 10 2 .0 Kiribati

228 222 205 25 254 441 561 634 567 559 1 .5 Lao People’s Democratic Republic

4 3 4 1 22 14 26 36 22 23 3 .0 Macao (China)

321 257 161 18 537 1155 1137 999 700 657 2 .5 Malaysia

7 4 2 2 6 6 7 13 7 4 1 .0 Marshall Islands

4 6 4 19 44 8 13 12 12 5 1 .1 Micronesia

81 24 29 23 689 600 421 238 88 70 1 .2 Mongolia

1 1 1 .0 Nauru

2 1 3 1 1 3 2 .0 New Caledonia

3 6 4 6 26 17 20 7 9 11 0 .9 New Zealand

Niue

1 1 2 4 6 2 1 0 .7 Northern Mariana Islands

1 2 2 1 5 .0 Palau

75 24 3 73 447 435 264 159 72 6 1 .0 Papua New Guinea

5007 3485 2237 798 12 215 17 443 19 108 17 740 11 559 6877 2 .2 Philippines

403 371 1705 46 1231 1968 1730 1809 1326 3403 1 .6 Republic of Korea

1 6 2 1 2 1 2 2 .5 Samoa

22 27 31 2 26 53 89 129 102 137 2 .8 Singapore

14 8 4 5 29 25 13 18 22 12 0 .8 Solomon Islands

Tokelau

2 2 1 2 1 2 6 1 .3 Tonga

1 2 1 1 0 .3 Tuvalu

4 3 12 12 3 8 4 0 .8 Vanuatu

2283 1996 4400 111 5588 9930 10 967 11 000 7033 11 808 2 .8 Viet Nam

Wallis and Futuna

29 600 26 458 33 598 3695 98 725 110 801 120 827 111 137 98 572 122 853 2.2 Western Pacific Region


8 | ANNEXES

Male Female

0–14 15–24 25–34 35–44 45–54 55–64 65+ 0–14 15–24 25–34 35–44

American Samoa

Australia 0 2 2 2 1 1 3 0 1 2 1


Cambodia 2 46 163 303 397 604 1071 2 45 143 221

China 1 39 45 47 63 96 139 1 30 26 22

Cook Islands

Fiji 0 9 17 8 16 19 25 1 15 8 12


Guam 0 7 8 15 29 31 113 0 0 0 8

Hong Kong (China) 1 16 17 24 29 46 111 2 13 17 10

Japan 0 2 5 6 9 15 34 0 3 4 3

Kiribati


Macao (China) 0 37 20 46 71 81 120 3 17 22 17

Malaysia 0 20 41 41 49 56 92 0 1 15 23

Marshall Islands

Micronesia 64 157 42 117 176 249 53 24 189 73 129

Mongolia 2 105 141 132 142 122 93 4 126 113 96

Nauru

New Caledonia 0 0 16 6 7 14 0 5 0 0

New Zealand 1 5 2 3 1 1 3 0 4 4 4

Niue


Palau

Papua New Guinea 2 36 47 34 37 40 4 3 38 46 39

Philippines 3 90 172 270 362 383 310 3 51 86 113

Republic of Korea 0 18 27 29 39 43 87 1 18 22 13

Samoa 16 17 8 13 25 52 19

Singapore 0 2 11 17 27 32 60 0 7 8 5

Solomon Islands 1 25 27 16 26 145 110 4 34 38 37

Tokelau

Tonga 0 9 0 0 33 83 136 0 10 16 45

Tuvalu

Vanuatu 2 21 19 8 50 79 0 5 32 57 16

Viet Nam 0 42 104 152 215 256 332 1 21 33 34

Wallis and Futuna

Western Pacific Region 1 39 51 56 74 96 129 1 28 28 25

Rates are per 100 000 population of each age/sex group. Rates are calculated excluding those countries for which breakdown of notified cases or population by age and sex is missing. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 43: New smear-positive case notification rates by age and sex, DOTS and non-DOTS, 2006


8 | ANNEXES

Female All

45–54 55–64 65+ 0–14 15–24 25–34 35–44 45–54 55–64 65+

American Samoa

0 1 1 0 2 2 1 1 1 2 Australia

63 60 151 3 22 29 35 60 80 164 Brunei Darussalam

343 483 527 2 46 153 259 367 533 714 Cambodia

23 34 40 1 34 36 35 44 66 87 China

Cook Islands

9 21 0 0 12 13 10 13 20 11 Fiji

0 25 42 3 14 5 7 10 18 29 French Polynesia

10 32 33 0 4 4 12 20 31 70 Guam

9 12 29 1 15 17 16 19 29 67 Hong Kong (China)

3 3 12 0 3 4 5 6 9 22 Japan

Kiribati

109 203 182 1 20 52 95 154 277 277 Lao People’s Democratic Republic

9 16 20 1 27 21 29 40 52 64 Macao (China)

24 34 26 0 11 28 32 37 45 57 Malaysia

Marshall Islands

88 243 173 45 172 57 123 132 246 119 Micronesia

70 43 49 3 116 127 114 105 81 68 Mongolia

Nauru

0 0 22 0 2 8 3 4 0 18 New Caledonia

1 3 1 1 4 3 3 1 2 2 New Zealand

Niue


Palau

34 20 4 3 37 46 37 35 30 4 Papua New Guinea

139 160 120 3 71 130 191 249 269 205 Philippines

11 16 61 1 18 25 21 25 29 72 Republic of Korea

15 17 9 4 14 13 23 Samoa

6 12 15 0 5 9 11 16 22 36 Singapore

91 85 56 3 29 32 26 58 115 83 Solomon Islands

Tokelau

0 0 56 0 9 8 22 15 37 92 Tonga

Tuvalu

51 0 0 3 26 38 12 50 41 0 Vanuatu

55 96 171 0 31 68 92 134 174 246 Viet Nam

Wallis and Futuna

28 36 42 1 34 40 41 51 67 83 Western Pacific Region


8 | ANNEXES

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993

American Samoa 2 6 6 8 12 5 8 9 13 5 9 3 1 4

Australia 1457 1386 1270 1219 1299 1088 906 907 954 952 1016 950 1011 991


Cambodia 2576 1980 8158 7572 10 241 10 145 10 325 9106 10 691 7906 6501 10 903 16 148 13 270

China 98 654 117 557 151 564 226 899 265 095 251 600 304 639 310 607 375 481 345 000 320 426 344 218

Cook Islands 8 2 12 15 3 8 3 2 2 1 6 5

Fiji 210 180 163 185 165 230 199 173 162 218 226 247 240 183

French Polynesia 76 66 65 78 80 78 85 80 63 73 59 49 83 78

Guam 55 41 49 48 54 37 49 34 41 75 60 70

Hong Kong (China) 8065 7729 7527 7301 7843 7545 7432 7269 7021 6704 6510 6283 6534 6537

Japan 70 916 65 867 63 940 62 021 61 521 58 567 56 690 56 496 54 357 53 112 51 821 50 612 48 956 48 461

Kiribati 146 187 193 127 111 103 129 110 208 121 68 91 100 99

Lao People’s Democratic Republic 7630 4706 4700 6528 4258 1514 3468 7279 2952 1826 1951 994 2093

Macao (China) 1101 585 233 455 671 571 420 389 320 274 343 329 294 285

Malaysia 11 218 10 970 11 944 11 634 10 577 10 569 10 735 11 068 10 944 10 686 11 702 11 059 11 420 12 285

Marshall Islands 6 7 12 15 12 15 37 32 11 7 26 52 61

Micronesia 67 73 75 66 60 98 77 68 367 350 111 151

Mongolia 1160 1094 1325 1514 1652 2994 2819 2433 2538 2233 1659 1611 1516 1418

Nauru 2 8 8 6 8 7

New Caledonia 108 128 120 171 144 104 98 74 111 128 143 140 140 104

New Zealand 474 448 437 415 404 359 320 296 295 303 348 335 317 274

Niue 1 2 3 1 5 3 2 1


Palau 17 10 17 14 20 26 13 38 17 3 6 4 25

Papua New Guinea 2525 2508 2742 2955 3505 3453 2877 2251 4261 3396 2497 3401 2540 7451

Philippines 112 307 116 821 104 715 106 300 151 863 151 028 153 129 163 740 183 113 217 272 317 008 207 371 236 172 178 134

Republic of Korea 89 803 98 532 100 878 91 572 85 669 87 169 88 789 87 419 74 460 70 012 63 904 57 864 48 070 46 999

Samoa 59 49 43 41 37 43 65 29 29 37 44 44 26 49

Singapore 2710 2425 2179 2065 2143 1952 1760 1616 1666 1617 1591 1841 1778 1830

Solomon Islands 266 313 324 302 337 377 292 334 372 488 382 309 364 367

Tokelau 1 2 9 1 1 1 1

Tonga 64 49 45 50 54 49 35 24 14 36 23 20 29 33

Tuvalu 33 18 12 23 9 32 27 22 24 26 23 30 30 28

Vanuatu 178 92 173 196 188 124 131 90 118 144 140 230 193 114

Viet Nam 43 062 43 506 51 206 43 185 43 875 46 941 47 557 55 505 52 463 52 270 50 203 59 784 56 594 52 994

Wallis and Futuna 23 24 5 17 14 14 34 1 30 22 4 11

Western Pacific Region 356 452 355 337 461 550 462 181 540 985 615 153 651 840 655 006 716 427 741 913 894 073 760 863 754 463 718 783

Number reporting 36 33 36 36 36 36 35 36 36 35 32 31 35 33

% reporting 100 92 100 100 100 100 97 100 100 97 89 86 97 92

From 1995, number shown is all notified new and relapse cases (DOTS and non-DOTS). The table includes updated information; data shown here may differ from those published in previous reports. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 44: Number of TB cases notified, 1980–2006


8 | ANNEXES

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

4 6 3 4 3 3 2 3 5 6 4 American Samoa

1057 1073 1145 899 1073 1043 980 1013 949 1059 1046 1159 Australia


15 172 14 603 14 857 15 629 16 946 19 266 18 891 19 170 24 610 28 216 30 838 35 535 34 660 Cambodia

363 804 515 764 504 758 466 394 445 704 449 518 454 372 470 221 462 609 615 868 790 603 894 428 940 889 China

4 2 1 2 3 1 2 1 1 1 1 Cook Islands

225 203 200 171 166 192 144 183 148 185 134 132 114 Fiji

89 86 91 105 93 62 62 64 50 60 63 69 French Polynesia

94 54 63 51 22 50 63 44 Guam

6319 6212 6501 7072 7673 5605 6015 6788 6277 5914 5684 5660 5356 Hong Kong (China)

44 425 43 078 42 122 42 190 44 016 40 800 39 384 35 489 32 828 31 638 29 736 27 194 25 304 Japan

253 327 464 276 255 252 189 196 284 310 332 378 Kiribati

1135 830 1440 1923 2149 2420 2227 2418 2621 2748 3162 3777 3958 Lao People’s Democratic Republic

402 570 575 465 449 465 388 371 309 355 374 Macao (China)

11 708 11 778 12 691 13 539 14 115 14 908 15 057 14 830 14 389 15 671 14 986 15 342 16 051 Malaysia

59 49 41 34 56 51 60 117 111 138 Marshall Islands

173 172 126 107 123 91 104 127 99 118 98 104 Micronesia

1730 2780 4062 3592 2915 3348 3109 3526 3829 3918 4542 4601 5049 Mongolia

4 2 4 3 5 3 11 12 Nauru

97 87 104 88 90 78 94 61 65 38 61 47 48 New Caledonia

352 391 352 321 365 447 344 377 329 386 371 332 344 New Zealand

2 2 1 4 Niue

46 48 51 93 97 66 75 58 53 45 53 57 51 Northern Mariana Islands

41 19 5 15 32 11 9 5 10 12 Palau

5335 8041 3195 7977 11 291 13 003 10 520 12 658 11 197 12 798 12 743 12 564 12 620 Papua New Guinea

180 044 119 186 165 453 195 767 162 360 145 807 119 914 107 133 118 408 132 759 130 530 137 100 147 305 Philippines

38 155 42 117 39 315 33 215 34 661 32 075 21 782 37 268 34 967 33 843 34 389 38 290 37 861 Republic of Korea

45 45 31 32 22 31 43 22 31 27 34 24 25 Samoa

1677 1889 1951 1977 2120 1805 1728 1536 1516 1581 1414 1356 1314 Singapore

332 352 299 318 295 289 302 292 256 293 340 397 371 Solomon Islands

2 Tokelau

23 20 22 21 30 22 24 12 29 16 12 18 18 Tonga

19 36 18 14 16 16 13 30 12 9 Tuvalu

152 79 126 184 178 120 152 175 101 104 115 76 126 Vanuatu

51 763 55 739 74 711 77 838 87 468 88 879 89 792 90 728 95 044 92 741 98 173 94 916 97 363 Viet Nam

11 6 8 14 1 19 15 7 Wallis and Futuna

724 290 824 954 873 425 870 920 834 599 820 469 786 285 805 105 811 482 980 890 1 160 130 1 274 124 1 331 333 Western Pacific Region

33 29 31 31 30 32 34 35 35 36 32 36 35 Number reporting

92 81 86 86 83 89 94 97 97 100 89 100 97 % reporting


8 | ANNEXES

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993

American Samoa 6 18 17 22 32 13 19 21 29 11 19 6 2 8

Australia 10 9 8 8 8 7 6 6 6 6 6 6 6 6


Cambodia 38 29 114 102 132 125 123 104 118 84 67 109 155 124

China 10 11 14 21 24 23 27 27 33 30 27 29

Cook Islands 45 11 68 85 17 45 17 11 0 11 0 6 33 28

Fiji 33 28 24 27 24 32 28 24 23 30 31 34 32 24

French Polynesia 50 42 41 47 47 45 48 44 34 38 30 25 41 38

Guam 52 38 44 42 46 31 40 27 32 57 43 50

Hong Kong (China) 160 150 144 137 145 138 135 131 126 119 114 109 111 109

Japan 61 56 54 52 51 48 47 46 44 43 42 41 39 39

Kiribati 267 333 335 214 182 164 200 166 304 172 95 124 135 132

Lao People’s Democratic Republic 246 145 141 191 121 42 93 190 75 45 46 23 47

Macao (China) 437 226 87 163 229 186 131 117 92 76 92 86 75 72

Malaysia 82 78 83 78 69 67 67 67 64 61 65 59 60 63

Marshall Islands 20 22 36 43 33 39 92 76 25 15 54 105 122

Micronesia 86 91 90 77 68 109 84 72 381 354 110 146

Mongolia 70 64 76 84 89 157 143 120 121 103 75 71 66 61

Nauru 0 26 104 0 0 0 96 70 91 0 77

New Caledonia 76 88 81 114 94 67 62 46 68 76 84 80 78 57

New Zealand 15 14 14 13 13 11 10 9 9 9 10 10 9 8

Niue 29 0 64 100 35 0 190 0 125 0 89 44


Palau 139 80 134 108 150 191 94 269 118 21 39 25 155

Papua New Guinea 79 77 82 86 99 95 77 59 109 84 60 80 58 167

Philippines 234 237 207 205 286 278 275 287 314 363 518 331 368 272

Republic of Korea 236 255 257 230 212 214 215 210 177 165 149 134 110 106

Samoa 38 32 28 26 24 27 41 18 18 23 27 27 16 30

Singapore 112 98 86 80 81 72 64 57 58 55 53 59 56 56

Solomon Islands 116 132 132 119 128 139 104 116 125 160 122 96 110 107

Tokelau 0 64 0 0 0 126 0 559 62 0 62 63 64

Tonga 66 51 47 53 58 53 38 26 15 38 24 21 30 34

Tuvalu 410 221 145 274 106 370 307 245 263 280 244 315 312 289

Vanuatu 152 77 141 156 146 94 97 65 83 99 94 150 122 70

Viet Nam 81 80 93 76 76 79 79 90 83 81 76 88 82 75

Wallis and Futuna 200 200 40 130 104 101 243 7 216 158 29 78

Western Pacific Region 27 27 34 34 39 44 46 45 49 50 59 50 49 46

Rates are per 100 000 population. The table includes updated information; data shown here may differ from those published in previous reports. Data can be downloaded from http://stoptb.wpro.who.int.

TABLE 45: Case notification rates, 1980–2006


8 | ANNEXES

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

8 0 11 5 7 5 5 3 5 8 9 6 American Samoa

6 6 6 5 6 5 5 5 5 5 5 6 Australia


137 128 127 130 138 154 148 147 186 209 225 255 244 Cambodia

30 42 41 38 36 36 36 37 36 47 61 68 71 China

22 11 6 11 0 18 6 13 7 0 7 7 7 Cook Islands

30 26 26 22 21 24 18 23 18 23 16 16 14 Fiji

42 39 41 46 40 26 26 26 20 24 25 27 French Polynesia

66 35 40 32 13 30 37 26 Guam

104 100 103 111 118 85 90 101 92 86 81 80 75 Hong Kong (China)

36 34 33 33 35 32 31 28 26 25 23 21 20 Japan

332 417 582 340 309 300 221 225 320 343 361 404 Kiribati

25 18 30 39 43 47 43 45 49 50 57 67 69 Lao People’s Democratic Republic

98 136 136 108 102 104 85 80 66 75 78 Macao (China)

58 57 60 62 64 66 65 62 59 63 59 60 61 Malaysia

115 95 79 65 106 95 110 211 196 238 Marshall Islands

163 160 117 99 114 85 97 118 91 108 89 94 Micronesia

73 116 169 148 119 136 126 142 153 155 178 178 194 Mongolia

41 20 40 30 50 30 109 118 Nauru

51 45 53 44 44 37 44 28 29 17 26 20 20 New Caledonia

10 11 9 9 10 12 9 10 8 10 9 8 8 New Zealand

88 0 91 0 0 51 0 0 228 0 0 0 0 Niue

83 83 85 149 150 99 109 81 72 59 68 71 62 Northern Mariana Islands

247 111 29 83 169 56 45 25 50 59 Palau

116 171 66 161 221 248 195 229 198 221 215 207 203 Papua New Guinea

268 174 236 273 222 195 157 138 149 164 158 162 171 Philippines

86 94 87 73 75 69 47 79 74 71 72 80 79 Republic of Korea

27 27 18 19 13 18 24 12 17 15 19 13 13 Samoa

50 54 54 53 56 46 43 37 36 37 33 31 30 Singapore

94 97 80 83 75 71 73 68 58 65 74 84 77 Solomon Islands

0 135 0 0 0 0 0 0 0 Tokelau

24 21 23 21 31 22 24 12 29 16 12 18 18 Tonga

195 367 179 138 157 156 126 290 115 86 Tuvalu

90 46 72 103 98 65 80 90 51 51 55 35 57 Vanuatu

72 76 100 103 114 114 114 113 117 112 117 112 113 Viet Nam


46 51 54 53 50 49 47 47 47 57 67 73 75 Western Pacific Region


8 | ANNEXES

Number of cases

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

American Samoa 1 4 6 2 3 2 2 1 2 2

Australia 557 226 203 285 251 228 210 113 285

Brunei Darussalam 68 102 84 95 112 121 115

Cambodia 11 058 11 101 12 065 12 686 13 865 15 744 14 822 14 361 17 258 18 923 18 978

China 84 898 104 729 134 488 203 670 236 021 202 817 201 775 204 765 204 591 194 972 267 414 384 886

Cook Islands 5 4 2 1 2 2 1 1

Fiji 61 62 68 69 66 74 65 62 73 74 78 62

French Polynesia 38 37 41 34 33 29 28 21 30

Guam 40 43 47 31 22

Hong Kong (China) 2429 1774 1943 2091 1536 1940 1857 1892 1794 1693

Japan 17 890 16 770 14 367 12 867 13 571 11 935 12 909 11 853 11 408 10 807 10 843 10 471

Kiribati 99 184 144 50 52 59 54 64 82 99 142


Macao (China) 108 141 258 325 276 160 157 147 138 128

Malaysia 6954 6861 6688 7271 7496 7802 8207 8156 8309 7958 7989 7843

Marshall Islands 12 12 11 17 11 15 18 20 39

Micronesia 9 14 9 14 15 8 22 26 35

Mongolia 145 455 769 1171 1356 1513 1389 1631 1670 1541 1808

Nauru 2 2 4 2 2 1

New Caledonia 16 28 21 26 24 26 22 20 19 21 12 15

New Zealand 91 61 78 90 83 106 94 74 68 88 106 111

Niue 1 1 1

Northern Mariana Islands 14 26 21 26 15 27 19 21 16 14

Palau 8 11 9 4 7 20 9 5 5

Papua New Guinea 1652 447 1195 2107 2140 1933 1351 1345 2310 1896

Philippines 92 279 87 401 94 768 86 695 80 163 69 476 73 373 67 056 59 341 65 148 72 670 78 163

Republic of Korea 16 630 13 266 11 754 11 420 9957 10 359 9559 8216 11 805 11 345 10 976 11 471

Samoa 21 18 15 9 14 7 17 13 11 19 12 11

Singapore 513 861 455 519 436 482 465 248 357 549 583 501

Solomon Islands 155 114 109 90 113 140 93 109 118 108 138 152

Tokelau 1

Tonga 16 17 9 14 11 16 10 15 8 23 11 8

Tuvalu 2 1 6

Vanuatu 62 30 50 66 38 43 63 57 38 40 59

Viet Nam 37 550 48 911 50 016 54 889 53 805 53 169 54 238 56 698 55 937 58 394

Wallis and Futuna 3 3 1 1 1 7

Western Pacific Republic 222 813 241 737 314 271 388 142 416 954 379 698 383 613 376 109 371 806 372 528 453 812 579 566

Rates are per 100 000 population. The table includes updated information; data shown here may differ from those published in previous reports. Data can be downloaded from http://stoptb.wpro.who.int/.

TABLE 46: New smear-positive cases notified, numbers and rates, 1993–2006


8 | ANNEXES

Rate (per 100 000 population)

2005 2006 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

3 3 2 8 0 11 4 5 4 3 2 3 3 5 5 American Samoa

241 269 3 1 1 2 1 1 1 1 1 1 1 Australia

101 128 24 0 31 25 28 32 34 31 27 34 Brunei Darussalam

21 001 19 294 100 97 103 106 113 126 116 110 130 140 138 150 136 Cambodia

472 719 468 291 7 9 11 17 19 16 16 16 16 15 21 29 36 35 China

1 28 22 11 6 11 0 0 0 13 7 0 7 7 0 Cook Islands

63 73 8 8 9 9 8 9 8 8 9 9 10 8 8 9 Fiji

21 24 18 17 18 15 14 12 0 11 8 12 8 9 French Polynesia

27 21 28 28 30 19 0 13 16 12 Guam

1561 1547 41 0 28 30 32 23 29 28 28 26 24 22 22 Hong Kong (China)

10 931 10 159 14 13 11 10 11 9 10 9 9 8 8 8 9 8 Japan

124 129 132 241 184 63 64 71 64 75 94 112 157 135 138 Kiribati

2806 3041 10 18 25 30 33 29 29 34 34 40 50 53 Lao People’s Democratic Republic

136 144 27 34 62 77 64 36 35 32 30 27 29 30 Macao (China)

8446 9414 36 34 32 34 35 35 36 35 35 33 32 31 33 36 Malaysia

48 45 24 23 21 33 21 28 34 37 70 85 78 Marshall Islands

32 41 8 13 8 13 14 7 20 24 32 29 37 Micronesia

1868 2129 0 6 19 32 48 56 62 56 66 67 61 71 72 82 Mongolia

2 20 20 40 20 20 10 0 20 Nauru

16 9 9 15 11 13 12 13 10 9 9 9 5 7 7 4 New Caledonia

83 97 3 2 2 2 2 3 2 2 2 2 3 3 2 2 New Zealand

0 0 0 45 0 0 51 0 0 57 0 0 0 0 Niue

15 15 24 43 34 40 22 39 27 29 21 18 19 18 Northern Mariana Islands

3 6 50 66 53 23 39 106 46 25 25 15 30 Palau

1805 1948 35 9 24 41 41 36 24 24 40 32 30 31 Papua New Guinea

81 647 85 740 141 130 138 124 112 95 98 88 76 82 90 94 97 99 Philippines

11 638 11 513 38 30 26 25 22 22 21 18 25 24 23 24 24 24 Republic of Korea

11 13 13 11 9 5 8 4 10 7 6 11 7 6 6 7 Samoa

552 538 16 26 13 14 12 13 12 6 9 13 14 12 13 12 Singapore

169 124 45 32 30 24 30 36 23 26 28 25 31 33 36 26 Solomon Islands

0 68 0 0 0 0 0 0 0 Tokelau

11 14 17 18 9 14 11 16 10 15 8 23 11 8 11 14 Tonga

5 4 21 10 61 0 0 0 0 0 48 38 Tuvalu

35 42 37 17 28 37 21 23 33 29 19 20 28 16 19 Vanuatu

55 492 56 437 51 66 66 71 69 67 68 70 68 70 65 65 Viet Nam


671 612 671 254 14 15 20 24 25 23 23 22 22 22 26 33 38 38 Western Pacific Republic


Country

New TB cases Re-treatment cases

Number Percentage Number Percentage

Est. Min. Max. Est. Min. Max. Est. Min. Max. Est. Min. Max.

Cambodia 0 0 332 0 .0 0 .0 0 .5 92 0 221 3 .1 0 .6 8 .9

China 65 853 41 883 90 663 5 .0 4 .6 5 .5 64 694 41 304 88 232 25 .6 23 .7 27 .5

Lao People’s Democratic Republic 322 46 1791 3 .7 0 .6 19 .9 76 16 241 19 .4 4 .0 58 .1

Mongolia 48 9 107 1 .0 0 .3 2 .5 68 13 204 20 .5 4 .3 59 .6

Papua New Guinea 563 82 3142 3 .6 0 .6 20 .0 352 66 1082 19 .5 4 .1 58 .6

Philippines 10 012 5676 15 135 4 .0 2 .9 5 .5 1836 1007 2810 20 .9 14 .3 29 .0

Viet Nam 4047 2341 6056 2 .7 2 .0 3 .6 2374 1378 3535 19 .3 14 .2 25 .4

Western Pacific Region 82 087 57 531 107 804 4.4 3.9 4.8 70 601 47 134 94 543 24.4 22.7 26.1

Est. = estimated; Min. = lower 95% CI bound; Max. = upper 95% CI bound

Annex 7: Multidrug-resistant TB

TABLE 47: Estimated numbers and proportion of MDR-TB cases in new TB and re-treatment cases in countries with a high burden of TB, 2006

Annex 8: Notified prevalence of resistance to anti-TB drugs (1997–2006)

TABLE 48: Notified prevalence of resistance to specific drugs among new TB cases tested for resistance

Country and Area Sub-national Year Method

Patients tested

Suscep-tible %

Any resis-tance % Any H % Any R % Any E % Any S % Mono % Mono H % Mono R %

Australia Countrywide 2005 Surveillancecombined

only . . . . . . . . .

Cambodia Countrywide 2001 Survey 638 572 89 .7 66 10 .3 41 6 .4 4 0 .6 1 0 .2 32 5 .0 54 8 .5 30 4 .7 3 0 .5

China Beijing 2004 Survey 1043 856 82 .1 187 17 .9 91 8 .7 44 4 .2 43 4 .1 95 9 .1 113 10 .8 35 3 .4 11 1 .1

China Henan 2001 Survey 1222 858 70 .2 364 29 .8 208 17 .0 117 9 .6 53 4 .3 271 22 .2 190 15 .5 40 3 .3 17 1 .4

China Heilongjiang 2005 Survey 1574 1005 63 .9 569 36 .1 268 17 .0 167 10 .6 93 5 .9 383 24 .3 340 21 .6 61 3 .9 34 2 .2

China Shanghai 2005 Survey 764 646 84 .6 118 15 .4 85 11 .1 37 4 .8 23 3 .0 62 8 .1 57 7 .5 25 3 .3 6 0 .8

ChinaInner

Mongolia2002 Survey 806 524 65 .0 282 35 .0 164 20 .3 79 9 .8 72 8 .9 172 21 .3 148 18 .4 40 5 .0 13 1 .6

Fiji Countrywide 2006 Surveillancecombined

only . . . . . . . . .

Guam Countrywide 2002 Surveycombined

only . . . . . . . . .

Hong Kong (China)

Hong Kong 2005 Surveillance 3271 2909 88 .9 362 11 .1 164 5 .0 36 1 .1 27 0 .8 274 8 .4 262 8 .0 66 2 .0 7 0 .2

Japan Countrywide 2002 Surveillance 2705 2472 91 .4 233 8 .6 77 2 .8 28 1 .0 23 0 .9 188 7 .0 184 6 .8 33 1 .2 5 0 .2

Macao (China)

Macao 2005 Surveillance 265 223 84 .2 42 15 .8 28 10 .6 7 2 .6 4 1 .5 27 10 .2 28 10 .6 14 5 .3 1 0 .4

New Caledonia

Countrywide 2005 Surveycombined

only . . . . . . . . .

New Zealand

Countrywide 2006 Surveillance 250 224 89 .6 26 10 .4 17 6 .8 1 0 .4 1 0 .4 18 7 .2 17 6 .8 8 3 .2 0 0 .0



Philippines Countrywide 2004 Survey 965 767 79 .5 198 20 .5 130 13 .5 44 4 .6 41 4 .2 115 11 .9 122 12 .6 57 5 .9 4 0 .4

Republic of Korea

Countrywide 2004 Survey 2636 2315 87 .8 321 12 .2 261 9 .9 98 3 .7 70 2 .7 70 2 .7 203 7 .7 145 5 .5 25 0 .9

Singapore Countrywide 2005 Surveillance 895 837 93 .5 58 6 .5 30 3 .4 5 0 .6 7 0 .8 35 3 .9 44 4 .9 16 1 .8 3 0 .3

Solomon Islands

Countrywide 2004 Surveycombined

only . . . . . . . . .

Vanuatu Countrywide 2006 Surveillance 29 28 96 .6 1 3 .4 1 3 .4 0 0 .0 0 0 .0 0 0 .0 1 3 .4 1 3 .4 0 0 .0

Viet Nam Countrywide 2006 Survey 1619 1122 69 .3 497 30 .7 310 19 .1 53 3 .3 42 2 .6 375 23 .2 291 18 .0 114 7 .0 5 0 .3

H = isoniazid; R = rifampicin; E = ethanbutol; S = streptomicin; Mono = mono-resistant to; HR = resistant only to H and R; HRE = resistant to H, R and E; HRS = resistant to H, R and S; HRES = resistant to H, R, E, and S; Poly = resistant to more than one drug other than MDR; HE = resistant to H and E; HS = resistant to H and S; HES = resistant to H, E, and S; RE = resistant to R and E; RS = resistant to R and S; RES = resistant to R, E, and S; ES = resistant to E and S.


8 | ANNEXES

Mono E %

Mono S % MDR % HR % HRE % HRS % HRES % Poly % HE % HS % HES % RE % RS % RES % ES %

. . . . . . . . . . . . . . . Australia

0 0 .0 21 3 .3 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 12 1 .9 1 0 .2 10 1 .6 0 0 .0 0 0 .0 1 0 .2 0 0 .0 0 0 .0 Cambodia

14 1 .3 53 5 .1 24 2 .3 15 1 .4 1 0 .1 5 0 .5 3 0 .3 50 4 .8 11 1 .1 21 2 .0 0 0 .0 5 0 .5 4 0 .4 0 0 .0 9 0 .9 Beijing

10 0 .8 123 10 .1 95 7 .8 18 1 .5 5 0 .4 47 3 .8 25 2 .0 79 6 .5 2 0 .2 62 5 .1 9 0 .7 1 0 .1 4 0 .3 0 0 .0 1 0 .1 Henan

3 0 .2 242 15 .4 113 7 .2 24 1 .5 63 4 .0 4 0 .3 22 1 .4 116 7 .4 0 0 .0 93 5 .9 1 0 .1 1 0 .1 18 1 .1 1 0 .1 2 0 .1 Heilongjiang

0 0 .0 26 3 .4 30 3 .9 7 0 .9 17 2 .2 1 0 .1 5 0 .7 31 4 .1 1 0 .1 29 3 .8 0 0 .0 0 0 .0 1 0 .1 0 0 .0 0 0 .0 Shanghai

5 0 .6 90 11 .2 59 7 .3 13 1 .6 29 3 .6 4 0 .5 13 1 .6 75 9 .3 9 1 .1 44 5 .5 12 1 .5 1 0 .1 6 0 .7 0 0 .0 3 0 .4Inner

Mongolia

. . . . . . . . . . . . . . .Fiji

. . . . . . . . . . . . . . . Guam

1 0 .0 188 5 .7 28 0 .9 5 0 .2 3 0 .1 9 0 .3 11 0 .3 72 2 .2 5 0 .2 60 1 .8 5 0 .2 1 0 .0 0 0 .0 0 0 .0 1 0 .0Hong Kong

(China)

2 0 .1 144 5 .3 19 0 .7 2 0 .1 3 0 .1 3 0 .1 11 0 .4 30 1 .1 0 0 .0 21 0 .8 4 0 .1 0 0 .0 2 0 .1 2 0 .1 1 0 .0 Japan

0 0 .0 13 4 .9 6 2 .3 0 0 .0 0 0 .0 3 1 .1 3 1 .1 8 3 .0 0 0 .0 7 2 .6 1 0 .4 0 0 .0 0 0 .0 0 0 .0 0 0 .0Macao

(China)

. . . . . . . . . . . . . . .New

Caledonia

0 0 .0 9 3 .6 1 0 .4 0 0 .0 0 0 .0 0 0 .0 1 0 .4 8 3 .2 0 0 .0 8 3 .2 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0New

Zealand

0 0 .0 1 5 .6 2 11 .1 2 11 .1 0 0 .0 0 0 .0 0 0 .0 1 5 .6 0 0 .0 1 5 .6 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0Northern Mariana

Islands

1 0 .1 60 6 .2 39 4 .0 10 1 .0 5 0 .5 5 0 .5 19 2 .0 37 3 .8 5 0 .5 21 2 .2 8 0 .8 1 0 .1 0 0 .0 0 0 .0 2 0 .2 Philippines

7 0 .3 26 1 .0 71 2 .7 24 0 .9 33 1 .3 4 0 .2 10 0 .4 47 1 .8 16 0 .6 26 1 .0 3 0 .1 1 0 .0 1 0 .0 0 0 .0 0 0 .0Republic of Korea

2 0 .2 23 2 .6 2 0 .2 0 0 .0 0 0 .0 0 0 .0 2 0 .2 12 1 .3 2 0 .2 9 1 .0 1 0 .1 0 0 .0 0 0 .0 0 0 .0 0 0 .0 Singapore

. . . . . . . . . . . . . . .Solomon

Islands

0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 Vanuatu

3 0 .2 169 10 .4 44 2 .7 0 0 .0 0 0 .0 20 1 .2 24 1 .5 162 10 .0 0 0 .0 143 8 .8 9 0 .6 0 0 .0 4 0 .2 0 0 .0 6 0 .4 Viet Nam


8 | ANNEXES

Country and Area Sub-national Year Method Patients tested

Suscep-tible %

Any resis-tance % Any H % Any R % Any E % Any S % Mono % Mono H % Mono R %

Australia Countrywide 2005 Surveillance combined only . . . . . . . . .






ChinaInner

Mongolia2002 Survey 308 92 29 .9 216 70 .1 174 56 .5 157 51 .0 98 31 .8 92 29 .9 52 16 .9 23 7 .5 16 5 .2

Fiji Countrywide 2006 Surveillance combined only . . . . . . . . .

Guam Countrywide 2002 Survey combined only . . . . . . . . .

Hong Kong (China)



Macao (China)


New Caledonia

Countrywide 2005 Survey combined only . . . . . . . . .

New Zealand


Northern Mariana

IslandsCountrywide 2006 Surveillance new only . . . . . . . . .


Republic of Korea



Solomon Islands

Countrywide 2004 Survey combined only . . . . . . . . .

Vanuatu Countrywide 2006 Surveillance new only . . . . . . . . .



TABLE 49: Notified prevalence of resistance to specific drugs among previously treated TB cases tested for resistance


8 | ANNEXES

Mono E %


. . . . . . . . . . . . . . . Australia

0 0 .0 1 1 .0 3 3 .1 1 1 .0 0 0 .0 2 2 .1 0 0 .0 4 4 .2 0 0 .0 4 4 .2 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 Cambodia

0 0 .0 8 5 .2 18 11 .7 6 3 .9 2 1 .3 7 4 .5 3 1 .9 19 12 .3 3 1 .9 8 5 .2 2 1 .3 1 0 .6 2 1 .3 0 0 .0 3 1 .9 Beijing

4 1 .5 15 5 .7 97 36 .6 20 7 .5 2 0 .8 41 15 .5 34 12 .8 26 9 .8 0 0 .0 13 4 .9 4 1 .5 2 0 .8 5 1 .9 1 0 .4 1 0 .4 Henan

0 0 .0 40 9 .5 128 30 .4 25 5 .9 58 13 .8 6 1 .4 39 9 .3 55 13 .1 3 0 .7 32 7 .6 2 0 .5 1 0 .2 17 4 .0 0 0 .0 0 0 .0 Heilongjiang

1 0 .5 5 2 .5 25 12 .5 6 3 .0 10 5 .0 2 1 .0 7 3 .5 11 5 .5 0 0 .0 7 3 .5 0 0 .0 0 0 .0 2 1 .0 1 0 .5 1 0 .5 Shanghai

0 0 .0 13 4 .2 129 41 .9 34 11 .0 48 15 .6 6 1 .9 41 13 .3 35 11 .4 2 0 .6 17 5 .5 3 1 .0 1 0 .3 9 2 .9 2 0 .6 1 0 .3Inner

Mongolia

. . . . . . . . . . . . . . . Fiji

. . . . . . . . . . . . . . . Guam

1 0 .6 6 3 .7 13 8 .0 3 1 .8 0 0 .0 4 2 .5 6 3 .7 10 6 .1 0 0 .0 8 4 .9 0 0 .0 1 0 .6 0 0 .0 1 0 .6 0 0 .0Hong Kong

(China)

1 0 .2 20 4 .8 41 9 .8 6 1 .4 6 1 .4 10 2 .4 19 4 .6 15 3 .6 3 0 .7 6 1 .4 3 0 .7 1 0 .2 0 0 .0 2 0 .5 0 0 .0 Japan

0 0 .0 1 5 .3 3 15 .8 1 5 .3 0 0 .0 1 5 .3 1 5 .3 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0Macao

(China)

. . . . . . . . . . . . . . .New

Caledonia

0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0New

Zealand

. . . . . . . . . . . . . . .Northern Mariana

Islands

0 0 .0 2 1 .6 27 20 .9 7 5 .4 4 3 .1 8 6 .2 8 6 .2 4 3 .1 0 0 .0 3 2 .3 0 0 .0 0 0 .0 1 0 .8 0 0 .0 0 0 .0 Philippines


0 0 .0 5 4 .8 1 1 .0 0 0 .0 0 0 .0 0 0 .0 1 1 .0 1 1 .0 0 0 .0 1 1 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 Singapore

. . . . . . . . . . . . . . .Solomon

Islands

. . . . . . . . . . . . . . . Vanuatu

2 1 .0 26 12 .6 40 19 .3 5 2 .4 0 0 .0 15 7 .2 20 9 .7 44 21 .3 0 0 .0 34 16 .4 8 3 .9 0 0 .0 2 1 .0 0 0 .0 0 0 .0 Viet Nam


8 | ANNEXES

Country and Area Sub-national Year Method

Patients tested

Suscep-tible %

Any resis-tance % Any H % Any R % Any E % Any S % Mono %

Mono H %

Mono R %

Australia Countrywide 2005 Surveillance 808 726 89 .9 82 10 .1 71 8 .8 14 1 .7 7 0 .9 35 4 .3 53 6 .6 43 5 .3 1 0 .1






China Inner Mongolia 2002 Survey 1114 616 55 .3 498 44 .7 338 30 .3 236 21 .2 170 15 .3 264 23 .7 200 18 .0 63 5 .7 29 2 .6

Fiji Countrywide 2006 Surveillance 38 38 100 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0

Guam Countrywide 2002 Survey 47 45 95 .7 2 4 .3 4 8 .5 2 4 .3 1 2 .1 2 4 .3 0 0 .0 0 0 .0 0 0 .0

Hong Kong (China)



Macao (China)


New Caledonia


New Zealand


Northern Mariana

IslandsCountrywide 2006 Surveillance

new only

. . . . . . . . .


Republic of Korea



Solomon Islands


Vanuatu Countrywide 2006 Surveillancenew only

. . . . . . . . .



TABLE 50: Notified prevalence of resistance to specific drugs among all TB cases tested for resistance


8 | ANNEXES

Mono E %


0 0 .0 9 1 .1 12 1 .5 1 0 .1 1 0 .1 5 0 .6 5 0 .6 17 2 .1 1 0 .1 15 1 .9 0 0 .0 0 0 .0 1 0 .1 0 0 .0 0 0 .0 Australia

0 0 .0 22 3 .0 3 0 .4 1 0 .1 0 0 .0 2 0 .3 0 0 .0 16 2 .2 1 0 .1 14 1 .9 0 0 .0 0 0 .0 1 0 .1 0 0 .0 0 0 .0 Cambodia

14 1 .2 61 5 .1 42 3 .5 21 1 .8 3 0 .3 12 1 .0 6 0 .5 69 5 .8 14 1 .2 29 2 .4 2 0 .2 6 0 .5 6 0 .5 0 0 .0 12 1 .0 Beijing

14 0 .9 138 9 .3 192 12 .9 38 2 .6 7 0 .5 88 5 .9 59 4 .0 105 7 .1 2 0 .1 75 5 .0 13 0 .9 3 0 .2 9 0 .6 1 0 .1 2 0 .1 Henan

3 0 .2 282 14 .1 241 12 .1 49 2 .5 121 6 .1 10 0 .5 61 3 .1 171 8 .6 3 0 .2 125 6 .3 3 0 .2 2 0 .1 35 1 .8 1 0 .1 2 0 .1 Heilongjiang

1 0 .1 31 3 .2 55 5 .7 13 1 .3 27 2 .8 3 0 .3 12 1 .2 42 4 .4 1 0 .1 36 3 .7 0 0 .0 0 0 .0 3 0 .3 1 0 .1 1 0 .1 Shanghai

5 0 .4 103 9 .2 188 16 .9 47 4 .2 77 6 .9 10 0 .9 54 4 .8 110 9 .9 11 1 .0 61 5 .5 15 1 .3 2 0 .2 15 1 .3 2 0 .2 4 0 .4Inner

Mongolia

0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 Fiji

0 0 .0 0 0 .0 2 4 .3 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 Guam

2 0 .0 230 5 .3 41 0 .9 8 0 .2 3 0 .1 13 0 .3 17 0 .4 100 2 .3 5 0 .1 85 2 .0 5 0 .1 2 0 .0 1 0 .0 1 0 .0 1 0 .0Hong Kong

(China)

3 0 .1 164 5 .3 60 1 .9 8 0 .3 9 0 .3 13 0 .4 30 1 .0 45 1 .4 3 0 .1 27 0 .9 7 0 .2 1 0 .0 2 0 .1 4 0 .1 1 0 .0 Japan

0 0 .0 14 4 .9 9 3 .2 1 0 .4 0 0 .0 4 1 .4 4 1 .4 8 2 .8 0 0 .0 7 2 .5 1 0 .4 0 0 .0 0 0 .0 0 0 .0 0 0 .0Macao

(China)

0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 1 20 .0 0 0 .0 1 20 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0New

Caledonia

0 0 .0 9 3 .4 1 0 .4 0 0 .0 0 0 .0 0 0 .0 1 0 .4 8 3 .0 0 0 .0 8 3 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0New

Zealand

. . . . . . . . . . . . . . .Northern Mariana

Islands

1 0 .1 62 5 .7 66 6 .0 17 1 .6 9 0 .8 13 1 .2 27 2 .5 41 3 .7 5 0 .5 24 2 .2 8 0 .7 1 0 .1 1 0 .1 0 0 .0 2 0 .2 Philippines


2 0 .2 28 2 .8 3 0 .3 0 0 .0 0 0 .0 0 0 .0 3 0 .3 13 1 .3 2 0 .2 10 1 .0 1 0 .1 0 0 .0 0 0 .0 0 0 .0 0 0 .0 Singapore

0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0 0 0 .0Solomon

Islands

. . . . . . . . . . . . . . . Vanuatu

5 0 .3 195 10 .7 84 4 .6 5 0 .3 0 0 .0 35 1 .9 44 2 .4 206 11 .3 0 0 .0 177 9 .7 17 0 .9 0 0 .0 6 0 .3 0 0 .0 6 0 .3 Viet Nam


8 | ANNEXES

TABLE 51: Notified prevalence of extensively drug resistant TB (XDR-TB) among MDR-TB, 2002–2007

Country and Area Source Year Method MDR

MDR tested for XDR FLQ %FLQ

lower95%CI

upper

95% CI XDR %XDRlower

95% CI upper95% CI

Representative survey or surveillance data

Australia Global Project, SRLs Australia2002-2005

surveillance 43 43 4 9 .3 1 2 .3

Hong Kong (China) Global Project, SRL Hong Kong 2005 surveillance 41 41 12 29 .3 6 14 .6

Japan Global Project, SRL Japan 2002 sentinel 60 55 21 38 .2 17 30 .9

Macao (China) Global Project 2005 surveillance 9 9 1 11 .1 0 0

New Zealand Global Project 2005 surveillance 4 4 2 50 0 0

Republic of Korea Global Project 2004 survey 110 110 13 11 .8 0 .1 19 .3 2 1 .8 0 6 .4

Singapore Global Project2002-2005

surveillance 14 14 1 7 .1 0 0

Risk groups and MDR-TB treatment programmes

PhilippinesGlobal Project GLC programme

2005-2006

Confirmed MDR for Tx

293 149 50 .9 45 56 .7 10 3 .4 1 .6 6 .2

FLQ = resistant to fluroquinolone; CI = confidence interval; SRL = Supranational Reference Laboratory; Tx = treatment; GLC: Green Light Committee


8 | ANNEXES

This report can also be downloaded at: http://stoptb.wpro.who.int/

Tuberculosis - World Health Organization...Tuberculosis control in the Western Pacific Region: 2008 Report 1. Tuberculosis – epidemiology. 2. Tuberculosis – prevention and control.

Documents